Asthma

Self-Study Examination

Instructions: After studying the text answer the following true/false or multiple choice questions.  Remember, there's only one answer to each question.

1. Select the incorrect statement about asthma from the following:

a) Unlike many chronic diseases, asthma often appears very early in childhood.
b) Patients with severe asthma are fewer in number than those with minor asthma.
c) Asthma is categorized as a condition with isolated episodes of bronchospasm in the lungs.
d) Most asthma care should be provided at the primary health care level.
e) The environmental factors, such as domestic mites and passive smoking, contribute significantly to the onset of asthma.

2. Select the incorrect statement from the following:

a) Atopy is one of the strongest predisposing factors for developing asthma.
b) Atopy is defined as a genetic susceptibility for developing immunoglobulin IgE.
c) Atopy occurs in 30 to 50% of the population.
d) Atopy is almost always a result of some childhood disease.
e) Atopy is also responsible for such diseases as conjunctivitis, eczema, and food allergy.

3. The recurrent episodes of airflow limitation in asthma have four forms. Select the incorrect response from the following:

a) acute bronchoconstriction
b) disordered lung function
c) swelling of the airway wall
d) chronic mucus plug formation
e) airway wall remodeling

4. Asthma occurs in all countries regardless of the level of development but appears to be more common in nonaffluent populations than in affluent.

a) True
b) False

5. Due to better health care and living conditions, asthma is on the decline in children.

a) True
b) False

6. Which of the following factors is not clearly linked to the increased prevalence of asthma?

a) allergy
b) environment
c) climate
d) diet
e) passive smoking

7. There is evidence indicating viral infections as the direct cause for the onset of asthma.

a) True
b) False

8. Asthma in most children will disappear when the patient reaches adulthood.

a) True
b) False

9. It has generally been established that the more severe the asthma in childhood, the more severe the asthma in adult life.

a) True
b) False

10. Select the incorrect statement from the following:

a) Atopy is considered the strongest identifiable risk factor for the development of asthma.
b) Majority of children and adults with well-documented asthma are atopic.
c) Not all individuals with atopy will develop asthma.
d) all of the above
e) none of the above

11. Which child will have a higher probability of developing asthma?

a) a child of non-atopic parents with asthma
b) child of atopic parents with asthma

12. There is no significant relationship between gender and asthma.

a) True
b) False

13. A great proportion of asthma patients are allergic to cats.

a) True
b) False

14. There is little evidence that active smoking is a risk factor for the development of asthma in general.

a) True
b) False

15. Aspirin has been conclusively identified as a causal and exacerbating factor for asthma in a significant proportion of adults and children.

a) True
b) False

16. Which of the following is not a characteristic symptom of asthma?

a) cough
b) chest pains
c) chest tightness
d) wheezing
e) dyspnea

17. The majority of patients with occupational asthma fully recover after they cease to work in the particular occupation that caused asthma.

a) True
b) False

18. Select the incorrect statement from the following:

a) Asthma is underdiagnosed and undertreated.
b) Asthma can be diagnosed on the basis of symptoms.
c) Many patients tolerate intermittent respiratory symptoms before obtaining a medical opinion.
d) Asthma is often diagnosed as a variant form of bronchitis.
e) "All that wheezes is not asthma."

19. Which of the following patient information would be least useful in the diagnosis of asthma?

a) history of colds
b) recurrent attacks of wheezing
c) cough or wheeze after exercise
d) attack of shortness of breath while at rest
e) troublesome cough at night

20. During asymptomatic periods, the physical examination of the respiratory system of an asthma patient may prove normal.

a) True
b) False

21. In a normal lung, flow limitation on forced expiration results in FEV1 -FVC ratios of

a) greater than 75%
b) less than 75%
c) 50%
d) less than 50%

22. Ideally, peak expiratory flow (PEF) should be measured first thing in the morning and last thing at night.

a) True
b) False

23. PEF values are usually close to the lowest levels

a) in the morning
b) at night
c) after inhaling a shortacting bronchodilator

24. For the diagnosis of asthma a diurnal variation in PEF should be

a) less than 20%
b) more than 20%

25. When the diagnosis of asthma is doubtful, the physician should do one of the following:

a) measure airway hyperresponsiveness
b) provoke the airways with a suspected sensitizing agent
c) antigen provocation
d) start a trial treatment with a shortacting beta2agonist and a corticosteroid
e) skin test with allergens

26. Health care professionals are increasingly encouraged to make a positive diagnosis of asthma in under 3-year-old children whenever recurrent wheezing, restlessness and cough occur.

a) True
b) False

27. Alternative causes of recurrent wheezing in infancy include all of the following except

a) infection of the sinuses
b) cystic fibrosis
c) recurrent milk inhalation
d) congenital heart disease
e) foreign body aspiration

28. Some infants with no atopic background who have recurrent episodes of wheeze associated with acute viral respiratory infections usually outgrow their symptoms in the preschool years and have no evidence of subsequent asthma.

a) True
b) False

29. The least reliable means of diagnosing asthma in infants is

a) nocturnal coughing
b) measure of airflow limitation
c) exercise- induced asthma symptoms
d) repeated coughing with viral illness

30. The diagnosis of asthma in elderly is difficult for all of the following reasons except

a) structural damage to the lung due to smoking
b) life-long exposure to inhaled environmental insults
c) difficulty in performing lung function tests
d) left ventricular failure

31. If the diagnosis of asthma in an elderly presents a problem, the physician should prescribe a trial treatment of oral corticosteroids and bronchodilators.

a) True
b) False

32. For nurses, latex has been identified as an agent causing asthma.

a) True
b) False

33. To arrive at a diagnosis of occupational asthma, all of the following factors would be useful except

a) occupational history
b) history of smoking
c) absence of asthma symptoms before beginning employment
d) relationship between development of symptoms at the workplace and reduction of these on withdrawal from the workplace

34. Wheezing is an important preliminary indicator of the diagnosis of asthma. Which of the two infants below would have the greater probability of the diagnosis of asthma?

a) wheezing in an infant under 6 months
b) wheezing in an 18-month infant

35. The severity of an acute exacerbation of asthma is often overestimated by patients.

a) True
b) False

36. A patient has daily symptoms of asthma which are exacerbated after activity and sleep. The patient also shows nighttime asthma symptoms at least once a week. How would you classify severity of asthma for this patient?

a) severe persistent
b) moderate persistent
c) mild persistent
d) intermittent persistent

37. The patient with "brittle asthma" has occasional episodes of respiratory symptoms and normal or near normal airway responsiveness in between episodes.

a) True
b) False

38. Breastfeeding has been found to reduce the incidence of asthma.

a) True
b) False

39. Which of the following measures would be most effective in the prevention of asthma?

a) reducing exposure to domestic mites
b) moving to a less polluted city
c) prevent viral infections
d) eat more fish and less eggs

40. Although asthma cannot be cured, it can be effectively controlled in most patients.

a) True
b) False

41. Carefully prepared questionnaires can be an effective method for detecting a dete rioration of asthma. Such a questionnaire would include all of the following questions except

a) family history of asthma
b) how frequently the patient is using reliever medication
c) how frequently the patient has experienced nighttime symptoms such as cough, wheezing or breathlessness
d) how frequently the patient limits normal activities

42. Measurements of lung function should be used in patients under 5 years old to monitor the course of asthma and the patients' response to therapy.

a) True
b) False

43. Select the incorrect statement from the following regarding PEF:

a) Ideally, PEF measurement should be taken twice daily.
b) If PEF measurements are taken only once daily, they should be done in the evening before going to bed.
c) If PEF is being measured only 2 or 3 times a week, it is best to do both a morning and an evening reading on the same day.
d) Any variation in PEF measurement taken before and after using a bronchodilator of greater than 20% would indicate worsening of asthma.

44. The objective of PEF measurements is to compare the patient's PEF values against the average predicted values, corrected for height, sex, race, and age.

a) True
b) False

45. Arterial blood gas measurement provides important information for:

a) assessing severity of an asthma exacerbation
b) assessing pulmonary function
c) determining variability of PEF
d) prescribing the level of medication

46. Exposure to domestic mite allergens in early childhood is known to be an important causal risk factor for development of asthma. The least effective or recommended method to reduce the number of mites is:

a) Mattresses, box springs and pillows should be encased appropriately.
b) Bed linens and blankets should be washed regularly in hot water to ensure mite killing.
c) Ideally, the carpets should be removed and replaced by vinyl or polished wooden floor boards.
d) Use of acaricides (substances that kill mites via chemical action)

47. In the control of indoor allergens maintaining a low humidity (less than 50%) is important.

a) True
b) False

48. To avoid outdoor air pollutants during intense air pollution episodes, patients with asthma should take all of the following steps except

a) avoid unnecessary physical activity
b) avoid exposure to dust and other irritants
c) try to stay indoors in a clean environment
d) if necessary, leave the polluted area temporarily
e) increase the dosage and frequency of beta-blocker drugs

49. Once a patient has been sensitized to occupational allergens, it takes a higher level of sensitizer to induce symptoms of asthma.

a) True
b) False

50. Food allergy is a frequent cause of asthma exacerbations in adults.

a) True
b) False

51. Which of the following food substances is strongly implicated in causing severe asthma exacerbations?

a) sulfites
b) yellow-dye tartrazine
c) benzoate
d) monosodium glutamate

52. Which of the following statements is not True in connection with specific immuno therapy?

a) Specific immunotherapy may be considered when avoiding allergens is not possible.
b) Specific immunotherapy is not recommended for patients with multiple allergen sensitivities..
c) Specific immunotherapy is more effective in the elderly than in children and young adults.
d) Specific immunotherapy has been demonstrated to be effective in asthma caused by grass pollen, domestic mites and animal dander.

53. Several clinical studies have shown that in asthma long-term treatment with anti- inflammatory agents is more effective than long-term treatment with broncodilators.

a) True
b) False

54. Which of the following routes of administration of medications for asthma is most effective?

a) inhalation
b) oral (ingested)
c) parenteral

55. The major disadvantage of pressurized metered-dose inhaler therapy is

a) Since a minimal inspiratory flow rate is necessary to inhale, it may be difficult for some patients to use during an exacerbation.
b) It requires training and skill to coordinate activation of the drug through inhalation.
c) Storage in humid climates is more difficult.

56. Which of the following delivery systems would be ideal for young children under 3 years of age?

a) metered-dose inhalers
b) dry powder system
c) nebulizers

57. Several studies have demonstrated that treatment with corticosteroids during one month or more significantly reduces the pathological signs of airway inflammation in asthma.

a) True
b) False

58. Inhaled corticosteroids are currently the most effective anti-inflammatory medications for the treatment of asthma.

a) True
b) False

59. Treatment with nedocromil sodium does not produce any significant adverse affects.

a) True
b) False

60. Select the incorrect statement from the following:

a) Long-acting inhaled beta2 -agonists are bronchodilator medications.
b) In addition to this bronchodilating action, these drugs influence a persistent inflammatory changes in asthma.
c) Generally, long-acting inhaled beta2-agonist should be considered when standard introductory doses of inhaled corticosteroids fail to achieve control of asthma.
d) These medications may also be used to prevent exercise-asthma.

61. Which of the following traditional methods of healing have proven effective in the treatment of asthma?

a) acupuncture
b) homeopathy
c) herbal medicine
d) Ayurvedic
e) none of the above

62. A patient with intermittent asthma (Step 1) requiring medication more than once a week over a 3-month period should be moved to the next step of care, regardless of PEF measurements to achieve and maintain control over asthma.

a) True
b) False

63. Patients with mild persistent asthma (Step 2) require controller medication on an as- needed basis.

a) True
b) False

64. The patient with moderate persistent asthma (Step 3) has a pretreatment baseline PEF of less than 60% of predicted or personal best.

a) True
b) False

65. Full recovery from asthma exacerbations is as sudden as the onset of the exacerbating episode.

a) True
b) False

66. Severe exacerbation of asthma would present all of the following symptoms except

a) the patient would talk in words instead of sentences
b) would have loud wheezing
c) PEF after initial bronchodilator would be between 60 and 80% predicted or personal best
d) respiratory rate would be greater than 30/min.

67. Which of the following treatments should be administered concurrently to achieve the most rapid resolution of an exacerbation of asthma?

a) administer oxygen to achieve arterial oxygen saturation of greater than or equal to 90%
b) administer inhaled mucolytic drugs
c) if necessary, sedate the patient
d) give antihistamines
e) provide chest physical therapy

68. A patient, having been admitted to the hospital for severe exacerbation of asthma, would be discharged on the basis of all but one of the following criteria:

a) the patient should be on discharged medications for at least 12-24 hours before leaving supervision.
b) short-acting inhaled beta2-agonist as needed no more frequently than every 4 hours
c) patient is able to walk comfortably
d) patient is not waking at night or in the early morning and needing his or her bronchodilator
e) PEF or FEV1 is more than 70-80% of predicted or personal best after short- acting inhaled beta2 -agonist.

69. Even when the safety of the medication during pregnancy has not been unequivocably proven, its use to obtain optimum control is justified.

a) True
b) False

70. Select the incorrect statement from the following:

a) Physical activity is an important trigger of asthma exacerbations.
b) Exercise-induced asthma (EIA) increases substantially in breathing dry cold air and is uncommon in hot, humid climates.
c) EIA can be treated effectively.
d) EIA patients should be advised to limit their sports and physical activities.

71. Patients often express their concerns about asthma to their clinicians. Which of the following is not a proper response to these concerns:

a) Death from asthma in rare.
b) People with asthma should avoid exercise.
c) Asthma cannot be cured, but it can be controlled.
d) Asthma medicines are safe if taken as prescribed.

72. Home monitoring peak expiratory flow rate (PFER) should be discouraged in patients as it only exacerbates anxiety and severity of asthma.

a) True
b) False

73. Exercise-induced asthma is usually at its worst

a) at the beginning of the exercise
b) at the peak of exercise
c) 5-10 minutes after stopping exercise
d) at night after the vigorous exercise day

74. Which of the following is not the correct advice to give a pregnant woman with asthma?

a) Avoid decongestants during pregnancy.
b) Most asthma medicines will not harm the baby.
c) Asthma symptoms may be most severe between 29 and 36 weeks of pregnancy.
d) Woman taking asthma medicines should not breastfeed the baby.

75. When an infant is having an asthma episode, which of the following is the correct advice?

a) Give the infant extra amounts of liquids to drink.
b) Have the infant breathe warm, moist air.
c) Let the infant breathe from a tightly-held bag over his or her nose and mouth.
d) Avoid giving the infant over-the-counter antihistamines and cold remedies.

76. Select the correct statement from the following:

a) Bronchodilator medicine must be taken at the earliest sign of asthma.
b) If the asthma episode persists, follow-up with anti-inflammatory medicine.
c) none of the above
d) both of the above