Asthma management and exacerbations — MCQs

A 21-year-old woman comes to the physician for the evaluation of dry cough and some chest tightness for the past several weeks. The cough is worse at night and while playing volleyball. She frequently has a runny nose and nasal congestion. Her mother has systemic lupus erythematosus. The patient has smoked one pack of cigarettes daily for the last 5 years. She does not drink alcohol. Her only medication is cetirizine. Her vital signs are within normal limits. Pulse oximetry on room air shows an oxygen saturation of 98%. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?

A 13-year-old boy with a history of asthma and seasonal allergies is currently using albuterol to manage his asthma symptoms. Recently, his use of albuterol increased from 1–2 days/week to 4 times/week over the past several weeks, though he does not experience his symptoms daily. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 74/min, and respiratory rate 14/min. His physical examination shows clear, bilateral breath sounds and normal heart sounds. What change should be made to his current treatment regimen?

A 28-year-old man makes an appointment with his general practitioner for a regular check-up. He has recently been diagnosed with asthma and was given a short-acting β2-agonist to use during acute exacerbations. He said he usually uses the medication 1–2 times per week. Which of the following is the most appropriate treatment in this case?

A cohort study was conducted to investigate the impact of post-traumatic stress disorder (PTSD) on asthma symptoms in a group of firefighters who worked at Ground Zero during the September 11, 2001 terrorist attacks in New York City and developed asthma in the attack's aftermath. The study compared patients who had PTSD with those who did not have PTSD in order to determine if PTSD is associated with worse asthma control. During a follow-up period of 12 months, the researchers found that patients with PTSD had a greater number of hospitalizations for asthma exacerbations (RR = 2.0, 95% confidence interval = 1.4–2.5) after adjusting for medical comorbidities, psychiatric comorbidities other than PTSD, and sociodemographic variables. Results are shown: ≥ 1 asthma exacerbation No asthma exacerbations PTSD 80 80 No PTSD 50 150 Based on these results, what proportion of asthma hospitalizations in patients with PTSD could be attributed to PTSD?

A 23-year-old man presents to his physician's office with increasing breathlessness over the past one month. He was diagnosed with asthma when he was a child and has been able to keep his symptoms under control with a Ventolin inhaler. However, over the past year or so he has found that he gets out of breath on several occasions during the week. He wakes up at least once a week with breathlessness. He finds that he feels out of breath during his weekly football matches, which never used to happen before. He has to sit down and take a couple of puffs of his inhaler to feel better. He has no other pertinent history at this moment, except that he started on a new job painting houses about 5 months ago. His physical examination does not show anything significant. His peak expiratory flow rate during spirometry averages about 85% of the normal value, after conducting the test 3 times. Which of the following would be the next best step in management?

A 24-year-old woman presents with episodic shortness of breath, chest tightness, and wheezing. She has noticed an increased frequency of such episodes in the spring season. She also has a history of urticaria. She has smoked a half pack of cigarettes per day over the last 5 years. Her mother also has similar symptoms. The physical exam is within normal limits. Which of the following findings is characteristic of her condition?

A 20-year-old man comes to the physician because of recurrent episodes of shortness of breath and a nonproductive cough for the past 4 months. He has two episodes per week, which resolve spontaneously with rest. Twice a month, he wakes up at night with shortness of breath. His pulse is 73/min, respirations are 13/min, and blood pressure is 122/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. Physical examination shows no abnormalities. Spirometry shows an FVC of 95%, an FEV1:FVC ratio of 0.85, and an FEV1 of 81% of predicted. Which of the following is the most appropriate initial pharmacotherapy?

A 60-year-old man presents to the emergency department complaining of worsening exertional dyspnea over the last week. He denies chest pain and lightheadedness but reports persistent cough with white sputum. His past medical history includes hypertension and diabetes mellitus. He has a 50 pack-year history of smoking but denies any illicit drug use or alcohol consumption. His temperature is 101°F (38.3°C), blood pressure is 154/104 mmHg, pulse is 110/min, respirations are 26/min, and oxygen saturation is 88% on a non-rebreather mask. Physical exam is notable for an obese man in distress. The anteroposterior diameter of the patient's chest is increased, and he has decreased breath sounds bilaterally with diffuse expiratory wheezing. Which of the following is the best next step in management?

A 40-year-old man with persistent moderate asthma presents for a pulmonary function test. His ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) is 0.69, and his FEV1 is 65% of his predicted values. What other findings can be expected in the remainder of his pulmonary function test?

A 10-year-old boy is brought in by his parents with increasing breathlessness. He was diagnosed with asthma about 2 years ago and has been on treatment since then. He was initially observed to have breathlessness, cough and chest tightness 2 or 3 times a week. He would wake up once or twice a month in the nighttime with breathlessness. At that time, his pediatrician started him on a Ventolin inhaler to be used during these episodes. His symptoms were well controlled until a few months ago when he started to experience increased nighttime awakenings due to breathlessness. He is unable to play outside with his friends as much because he gets winded easily and has to use his inhaler almost daily to help him breathe easier. He is able to walk and perform other routine activities without difficulty, but playing or participating in sports causes significant struggles. Based on his symptoms, his pediatrician adds an inhaled formoterol and budesonide combination to his current regime. During spirometry, which of the following peak expiratory flow rates will most likely be observed in this patient?