Asthma in children Fitz Flashcards
- Which of the following best describes the pathophysiology and resulting clinical presentation of
asthma?
A. intermittent airway inflammation with occasional
bronchospasm
B. a disease of bronchospasm leading to airway
inflammation
C. chronic airway inflammation with superimposed
bronchospasm
D. relatively fixed airway constriction
C. chronic airway inflammation with superimposed
bronchospasm
- A 6-year-old boy has a 1-year history of moderate
persistent asthma that is normally well controlled
with budesonide via dry powder inhaler (DPI) twice
a day and the use of albuterol once or twice a week as
needed for wheezing. Three days ago, he developed a sore throat, clear nasal discharge, and a dry cough.
In the past 24 hours, he has had intermittent
wheezing, necessitating the use of albuterol
two puffs with use of an age-appropriate spacer
every 3 hours with partial relief. Your next most
appropriate action is to obtain:
A. a chest radiograph.
B. an oxygen saturation measurement.
C. a peak expiratory flow (PEF) measurement.
D. a sputum smear for WBCs.
C. a peak expiratory flow (PEF) measurement.
210. You see a 4-year-old girl who has a 2-day history of signs and symptoms of an acute asthma flare resulting from viral upper respiratory tract infection. She is using inhaled budesonide and albuterol as directed and continues to have difficulty with increased occurrence of coughing and wheezing. Her respiratory rate is within 50% of upper limits of normal for her age. Her medication regimen should be adjusted to include: A. oral theophylline. B. inhaled salmeterol (Serevent®). C. oral prednisolone. D. oral montelukast (Singulair®).
C. oral prednisolone.
- Which of the following is inconsistent with the
diagnosis of asthma?
A. a troublesome nocturnal cough
B. cough or wheeze after exercise
C. morning sputum production
D. colds “go to the chest” or take more than 10 days to
clear
C. morning sputum production
- Celeste is a 9-year-old girl with moderate persistent asthma. She is not taking a prescribed inhaled corticosteroid but is using albuterol PRN to relieve her cough and wheeze. According to her mother, she currently uses about six albuterol doses per day, in particular for cough and wheeze after active play. You consider that:
A. albuterol use can continue at this level.
B. excessive albuterol use is a risk factor for asthma
death.
C. she should also use salmeterol (Serevent®) to reduce
her albuterol use.
D. active play should be limited to avoid triggering
cough and wheeze.
B. excessive albuterol use is a risk factor for asthma
death.
213. In the treatment of asthma, a leukotriene modifier (LTM) should be used as: A. long-acting bronchodilators. B. an inflammatory inhibitor. C. a rescue drug. D. intervention in acute inflammation.
B. an inflammatory inhibitor.
- Which of the following is not a risk factor for asthma death?
A. hospitalization or an emergency department visit
for asthma in the past month.
B. current use of systemic corticosteroids or recent
withdrawal from systemic corticosteroids.
C. difficulty perceiving airflow obstruction or its
severity.
D. rural residence.
D. rural residence.
- A middle-school student presents, asking for a letter stating that he should not participate in gym class because he has moderate persistent asthma. The most appropriate response is to:
A. write the note because gym class participation
could trigger an asthma flare.
B. excuse him from outdoor activities only to avoid
pollen exposure.
C. remind him that with appropriate asthma care, he
should be capable of participating in gym class.
D. excuse him from indoor activities only to avoid
dust mite exposure.
C. remind him that with appropriate asthma care, he
should be capable of participating in gym class.
216. After inhaled corticosteroid or leukotriene modifier therapy is initiated, clinical effects are seen: A. immediately. B. within the first week. C. in about 1 to 2 weeks. D. in about 1 to 2 months.
C. in about 1 to 2 weeks.
- Compared with albuterol, levalbuterol (Xopenex®):
A. has a different mechanism of action.
B. has the ability to provide greater bronchodilation
with a lower dose.
C. has an anti-inflammatory effect similar to an
inhaled corticosteroid.
D. is contraindicated for use in children.
B. has the ability to provide greater bronchodilation
with a lower dose.
- In caring for a child with an acute asthma flare, the
NP considers that, according to the National Asthma
Education and Prevention Program, Expert Panel
Report 3 guidelines, antibiotic use is recommended:
A. routinely.
B. with evidence of concomitant bacterial infection.
C. when asthma flares are frequent.
D. with sputum production.
B. with evidence of concomitant bacterial infection.
- Which of the following is most consistent with
asthma in a 4-year-old child?
A. inspiratory stridor
B. expiratory wheezing
C. chronic cough with purulent sputum
D. loud “barking” cough predominantly during
the day
A. inspiratory stridor
221. Signs of respiratory distress during an asthma flare in a 2-year-old child include all of the following except: A. drowsiness. B. confusion. C. respiratory rate <30/minute. D. softer, shorter cry.
C. respiratory rate <30/minute.
222. Haley is a 6-year-old with moderate persistent asthma who presents for a follow-up visit. The NP administers the Asthma Control Test (ACT) and she scores a 22. This would indicate: A. well-controlled asthma. B. not well-controlled asthma. C. poorly controlled asthma. D. very poorly controlled asthma.
A. well-controlled asthma.
- Which of the following would you not expect for
Haley (question 222)?
A. nighttime awakening about once a week
B. asthma symptoms occurring about 2 times per week
C. asthma having little to no interference with normal
activities
D. SABA use 2 days or less per week
A. nighttime awakening about once a week
