ASTHMA

1. A 14 years old boy comes to you for evaluation of shortness of breath over the last several months.
He states the his symptoms are mostly worse at night. Physical examination is unremarkable.
Pulmonary function tests are ordered which revealed the following results:
FEV1 = 95%
FVC = 92%
DLCO = 110%
FEV1 decreases by 25% with methacoline. Which of the following is the most likely diagnosis?
a) Emphysema
b) Alpha-1 antitrypsin deficiency
c) Asthma
d) Chronic bronchitis
e) Allergic bronchopulmonary aspergillosis
f) Obstructive sleep apnea

2. A 14 years old boy comes to you for evaluation of shortness of breath over the last several months.
He states the his symptoms are mostly worse at night.. Pulmonary function tests are ordered which
revealed the following results:
FEV1 = 95%
FVC = 92%
DLCO = 110%
FEV1 decreases by 25% with methacoline. Which of the following is most likely to be associated with
this condition?
a) Glomerulonephritis
b) Atopic dermatitis
c) Seborrhic dermatitis
d) Icthyosis vulgaris

e) Serum sickness
3. A 15 years old boy comes to the office because of occasional shortness of breath every few weeks.
Currently he feels well. He uses no medications and denies any other medical problems. Physical
examination reveals a pulse of 70 and respiratory rate of 12 per minute. Chest examination is normal.
Which of the following is the single most accurate test at this time?
a) Peak expiratory flow
b) Increase in FEV1 with albuterol
c) DLCO
d) >20% decrease in FEV1 with methacoline
e) Increased A-a gradient
f) Flow volume loop on spirometry
g) Chest CT scan
h) ABGs
4. A 15 years old male presents to the physician office for a routine health maintenance examination.
He has a 2 year history of bronchial asthma for which he takes an albuterol inhaler. He states that he
experiences asthma symptoms an average 2 times per week, for which his albuterol inhaler provides
relief. He has not had nighttime awakenings over the past month. He does not uses tobacco, alcohol
or illicit drugs. His family history is significant for atopic dermatitis in his grandfather. Physical
examination is unremarkable. Which of the following is the next best step in the management?
a) Add oral prednisone
b) Add oral theophylline
c) Add long acting beta-2 agonist inhaler
d) Continue the current medical regimen
e) Add inhaled corticosteroids
5. A 34 years old male presents to his physician for a routine health maintenance examination. He has
a five year history of bronchial asthma for which he uses an albuterol inhaler. He says that he uses
albuterol inhaler an average of 2 times per week during the day In addition, he states that his asthma
symptoms wake him from sleep approximately 3-4 times per month. He does not use tobacco, alcohol
or illicit drugs. His family history is significant for asthma in his grandfather. Physical examination is
unremarkable. Which of the following is the most appropriate next step in the management?
a) Add oral prednisone
b) Add oral theophylline
c) Add long acting beta-2 agonist inhaler
d) Continue the current medical regimen
e) Add inhaled corticosteroids
6) A 34 years old male presents to his physician for a routine health maintenance examination. He has
a five year history of bronchial asthma for which he uses an albuterol inhaler. He says that he uses
albuterol inhaler an average of 2 times per week during the day In addition, he states that his asthma
symptoms wake him from sleep approximately 3-4 times per month. He does not use tobacco, alcohol
or illicit drugs. His family history is significant for asthma in his grandfather. Physical examination is
unremarkable. He asks, What is the best initial long term control treatment for asthma. What
should be your answer?
a) Oral prednisone
b) Inhaled corticosteroids

c) Long acting beta agonist

d) Albuterol inhaler
e) Omalizumab
f) Cromolyn sodium
g) Monterleukast
7. A 22 years old woman comes to you for health maintenance examination. She is a diagnosed case
of asthma 2 years ago and is currently taking albuterol and inhaled corticosteroids. She also reports a
dry cough that wakes her up during the night 3-4 times per week. She does not have any post-nasal
drip, heart burn, sorethroat, morning hoarsness or halthosis. Which of the following is the next best
step in the management for this lady?
a) Add oral prednisone
b) Add oral theophylline
c) Add long acting beta-2 agonist inhaler
d) Continue the current medical regimen
e) Add inhaled corticosteroids
8. An obese 55 years old female presents to her physician concerned that her asthma is worsening.
She describes nighttime cough and wheezing that have been increasing over recent months. She also
reports feeling tierd each morning because she works late hours and has no time to relax after dinner.
On review of system, the patient denies dyspnea on exertion, but acknowledges that her throat has
been sore lately. She also describes hoarsness in the morning that clears during the day. Her past
medical history is significant for bronchial asthma, type-2 diabetes mellitus and hypertension. Her
medications include albuterol inhaler which she uses occasionally, lisinopril and aspirin. There has
been no change of her medications for years. Her vital signs are within normal limits and there are no
abnormalities on physical examination. Which of the following is the most appropriate next step in
the management?
a) Discontinue lisinopril
b) Discontinue aspirin
c) Add inhaled b-2 agonist
d) Add inhaled corticosteroids
e) Add benzocaine lozenges
f) Add pantoprazole
9. A 19 years old woman presents to her physician for a routine health maintenance examination. She
notes experiencing occasional wheezing and breathlessness following aerobic exercise, but has no
symptoms at other times of the day or night. Her medical history is otherwise significant for allergic
rhinitis and acne for which she is using topical benzoyl peroxide and erythromycin cream. She does
not uses tobacco, alcohol or illicit drugs. On physical examination, her vital signs are within normal
limits and chest auscultation is unremarkable. Which of the following is the most appropriate next
step in the management?
a) Beta-adrenergic agonists before exercise
b) Daily oral steroids
c) Daily steroid inhalers
d) Daily oral theophylline
e) Ipratropium inhalers before exercise

10. A 27 years old man who is a diagnosed patient of asthma comes to you. He has symptoms of
asthma almost every day and has been to the ED 2 times over the past 6 months. He uses inhaled
albuterol over 5 times/day to control symptoms, Salmetrol inhaler at night, Inhaled triamcinolone and
oral prednisone 20mg daily. Lung examination reveals normal vesicular breathing with prolonged
expiratory phases with diffuse wheezing. Which of the following will you do next?
a) Add Cyclophosphamide
b) Continue current medication regimen
c) Add theophylline
d) Give him Leukotriene modifiers and taper the oral prednisone
e) Perform Methacoline challenge test

ASTHMA BONUS QUESTIONS (FOR HIGH SCORE)

1. A 26 years old male comes to you for evaluation of persistant asthma despite the use of inhaled
bronchodilators and inhaled corticosteroids. His asthma has taken a turn for the worse over the past
few months. He also complaints of sputum with brown plugs. Chest X-RAY reveals bilateral infiltrates
on the upper lobes and several tram-track markings. CBC reveals marked eosinophilia and total serum
IgE is elevated. Which of the following is the most likely diagnosis?
a) Chrug strauss syndrome
b) Wegener granulomatosis
c) Allergic bronchopulmonary aspergillosis
d) Pulmonary histoplasmosis
e) Acute exacerbation of asthma
f) Reactivation of latent Tuberculosis
2. A 26 years old male comes to you for evaluation of persistant asthma despite the use of inhaled
bronchodilators and inhaled corticosteroids. His asthma has taken a turn for the worse over the past
few months. He also complaints of sputum with brown plugs. Chest X-RAY reveals bilateral infiltrates
on the upper lobes and several tram-track markings. CBC reveals marked eosinophilia and total serum
IgE is elevated. Which of the following is the most appropriate treatment for him?
a) Long acting beta agonist
b) High dose inhaled corticosteroids
c) High dose oral corticosteroids
d) Isoniazid, Rifampin, Ethambutol and pyrazinamide
e) Monterleukast
f) Cyclophosphamide
3. A 20 years old woman with new-onset asthma is admitted to the hospital for "Asthma
Exacebratin". Two months ago, her Serum IgE and eosionphils were both elevated. C-XRAY on
admission shows multiple infiltrates on both lungs. Urinalysis reveals Red blood cells and protein and
there is Raised serum creatinine. Which of the following is the most likely diagnosis?
a) Goodpastures syndrome
b) Wegener granulomatosis
c) Allergic bronchopulmonary aspergillosis
d) Churg Strauss Syndrome
e) Leukotriene induced nephrotoxicity
f) Steroid induced renal failure as she had been treated for asthma