Deck 27: Asthma

Question 1

The therapist has been asked to check the Feno on a patient with asthma. The level is <15 ppb. How should the therapist interpret this data?

A) The asthma is well controlled.
B) The patient is less likely to respond to corticosteroids.
C) The patient is likely to require immunotherapy.
D) The patient has a neutrophilic phenotype of asthma.

Answer 1

B
Many clinicians today use Feno to determine the eosinophilic response to corticosteroids, unmasking of otherwise unsuspected nonadherence to therapy, and routine monitoring. According to the ATS Clinical Practice Guidelines, a patient with a low Feno level of less than 25 parts per billion (ppb) is considered less likely to respond to corticosteroids than one with a high FENO level of >50 ppb who is symptomatic. An intermediate is considered to be between 25 to 50 ppb.

Question 2

The respiratory therapist is assisting the pulmonologist on a methacholine challenge. After inhalation of the fourth concentration of methacholine, the FEV₁ decreases by 12%. What should the therapist suggest at this time?

A) Stop the challenge because a drop in the FEV₁ is consistent with a positive test.
B) Stop the challenge because only four concentrations are delivered.
C) Administer one more concentration to confirm that FEV₁ drop is in fact 12%.
D) Continue administering methacholine until FEV₁ decreases 20%.

Answer 2

D
The patient's FEV₁ is measured after inhalation of each concentration until there is a 20% decrease in the FEV₁ or until all nine concentrations have been delivered. A 20% decrease in the FEV₁ is considered a positive challenge.

Question 3

Which of the following spirometric criteria are used to determine the presence of airway obstruction?

A) FEV₁ less than 80% of predicted and FEV₁/FVC less than 80%
B) FEV₁ less than 60% of predicted and FEV₁/FVC less than 60%
C) FEV₁ less than 80% of predicted and FEV₁/FVC less than 65%
D) FEV₁ less than 65% of predicted and FEV₁/FVC less than 80%

Answer 3

C
Airway obstruction is indicated when the FEV₁ is less than 80% of the predicted value and FEV₁/FVC values are less than 65% (or below the lower limit of normal).

Question 4

Persistent inflammation in asthma leads to a remodeling phase that is characterized by which of the following processes?

A) Bronchoconstriction
B) Mucous hyporsecretion
C) Airway smooth muscle hypertrophy
D) Ciliary paralysis

Question 5

In order to establish the personal best peak flow, which instructions should the asthma educator give the patient?
I) Record peak flows when free of symptoms.
II) Record peak flows once a week for 2 to 3 weeks.
III) Record peak flows preferably in the early afternoon.
IV) Maintain peak flow values within 80% of the best peak flow.

A) I, III, and IV only
B) II and IV only
C) I, II, and III only
D) I, III, and IV only

Question 6

Which of the following medications is indicated for a 15-year-old patient with asthma who is not controlled with inhaled corticosteroids and exhibits the following signs: (1) a positive skin test or positive in vitro test for aeroallergens and (2) an IgE level of 500 IU/L?

A) Zileuton
B) Salmeterol
C) Xopenex
D) Omalizumab

Question 7

On the basis of the National Asthma Education and Prevention Program (NAEPP) guidelines, when a diagnosis of asthma is being made, which of the following criteria are recommended?
I) That the patient be free of any comorbidity
II) That a physical examination be performed
III) That spirometry is conducted to determine the presence of reversible disease
IV) That a detailed medical history be conducted

A) I and III only
B) I, II, and III only
C) I, III, and IV only
D) II, III, and IV only

Question 8

What appears to be the strongest identifiable predisposing factor for developing asthma?

A) Atopy
B) Genetics
C) Socioeconomic status
D) Race

Question 9

Which of the following has been identified as a key molecule in mediating allergic asthma?

A) Interleukin 4
B) Basophils
C) IgE
D) Neutrophils

Question 10

Which of the following medications are considered the first line of chronic treatment for patients with asthma?

A) Short-acting beta-2 adrenergic agonists
B) Leukotriene modifiers
C) Methylxanthines
D) Inhaled corticosteroids

Question 11

Which of the following are considered phases of inflammation?
I. Release of histamine, heparin, and tryptase
II. A decline in lung function and irreversible obstructive lung disease
III. A remodeling phase
IV. An allergen reintroduced into the system

A) I and IV only
B) I, II, and III only
C) I, II, and IV only
D) II, III, and IV only

Question 12

The respiratory therapist is performing an exercise challenge for a child suspected of having exercise-induced bronchospasm. After 30 minutes of stopping exercise, the FEV₁ has decreased 15% from baseline. How should the therapist interpret this information?

A) The challenge is consistent with a positive test for EIB.
B) The challenge is consistent with a positive test for asthma.
C) The challenge test is inconclusive for EIB.
D) The therapist needs to wait 30 more minutes before interpreting the results.

Question 13

Which of the following is an exaggerated bronchoconstricting response to stimuli?

A) Hyperresponsiveness
B) Antigen-antibody reactions
C) Bronchoprovocation
D) Bronchial mucosal edema

Question 14

Which of the following is con?

A) Adenovirus
B) Parainfluenza virus
C) Respiratory syncytial virus (RSV)
D) Coxsackievirus

Question 15

The therapist is asked to explain to a 10-year-old how to use a corticosteroid inhaler. Which of the following side effects should the therapist mention to the patient and caregiver?

A) Headache
B) Blurred vision
C) Changes in pupillary size
D) Oral candidiasis

Question 16

How is significant clinical airflow limitation determined from pre- and postbronchodilator spirometry?

A) When the patient's FEF 25% to 27% increases by 12% and 200 mL/second
B) When the patient's FEV₁ increases by 12%
C) When the FVC increases by 20% and 200 mL
D) When the FEV₁/FVC ratio increases by 25%

Question 17

Which of the following pharmacologic agents may be used for bronchoprovocation challenge testing?

A) Albuterol
B) Ipratropium bromide
C) Heparin
D) Methacholine

Question 18

Which of the following pathophysiologic events are responsible for airway obstruction?
I) Airway remodeling
II) Airway edema
III) Gas velocity
IV) Mucous plugging

A) I and IV only
B) I, II, and III only
C) I, II, and IV only
D) II, III, and IV only

Question 19

Which of the following spirometric measurements is sensitive to small changes in airway caliber and decreases in value with increasing obstructive disease?

A) Forced vital capacity (FVC)
B) Forced expiratory flow between 200 and 1200 mL of the FVC (FEF 200-1200)
C) Mean forced expiratory flow during the middle half of the FVC (FEF 25-75)
D) Forced expiratory volume in 1 second (FEV₁)

Question 20

The therapist is asked to recommend a quick-onset, long-acting beta-2 agonist to be added to the inhaled corticosteroid for a patient with asthma. Which of the following medications should the therapist recommend?

A) Formoterol
B) Salmeterol
C) Tiotropium bromide
D) Albuterol

Question 21

What is typically the first pharmacologic intervention instituted by the therapist to treat a patient who enters the emergency room with an asthmatic episode?

A) Three 20-minute administrations of salmeterol via a small-volume nebulizer in the first hour
B) Three treatments with albuterol given every 20 to 30 minutes by nebulization
C) Intravenous administration of corticosteroids
D) Combination therapy with a short-acting agonist and an anticholinergic bronchodilator via a metered dose inhaler (MDI)

Question 22

When endotracheal intubation and mechanical ventilation are indicated for a pediatric patient with asthma, which of the following ventilator setting adjustments should the therapist consider making?

A) 25% inspiratory pause
B) Tidal volume 10 mL/kg
C) Low to moderate positive end-expiratory pressure (PEEP)
D) Low FiO₂