1. Asthma is a common condition in the United States but it is less prevalent in other industrialized countries.

• a. True
• b. False

2. In children:

• a. Asthma is rare in both boys and girls.
• b. More boys than girls have asthma.
• c. More girls than boys have asthma.
• d. Approximately the same number of boys and girls have asthma.

3. In adults:

• a. Asthma is rare in both men and women.
• b. More men than women have asthma.
• c. More women than men have asthma.
• d. Approximately the same percent of men and women have asthma.

4. Most people are first diagnosed with asthma in their:

• a. Childhood.
• b. Young adult years.
• c. Mature years (age 50 and older).

5. Once they have been diagnosed with asthma, almost all:

• a. Patients will have asthma symptoms throughout their life.
• b. Children will lose their symptoms permanently during their teen years.
• c. Adults will lose their symptoms late in life.
• d. Adults will continue to have symptoms throughout their life.

6. The main underlying disease process in asthma is:

• a. A genetic muscle disorder in the airways.
• b. A genetic thickening of various internal secretions.
• c. Chronic inflammation of the airways.
• d. Occasional inflammation of the airways.

7. Mast cells:

• a. Are missing from the airway walls of patients with asthma.
• b. Are only found in the airway walls of patients with asthma.
• c. Secrete histamine when activated.
• d. Are named for their single spike, which looks like a ship's mast.

8. The major cause of the airflow limitation in asthma is:

• a. Bronchoconstriction.
• b. Excess mucus secretion.
• c. Congenital narrowing of the bronchi.
• d. Lack of cartilage in the bronchioles.

9. Airway remodeling refers to:

• a. The body's attempts to repair airways damaged by chronic inflammation.
• b. A surgical procedure that rebuilds asthmatic airways.
• c. The tendency of asthmatic airways to constrict and swell in response to triggers.
• d. The changes in shape of airways as a patient forcefully exhales.

10. The tendency to develop asthma is:

• a. Due to a bacterial antigen passed from mother to fetus.
• b. Genetically inherited.
• c. Limited to certain ethnic groups.
• d. Acquired from respiratory viruses as a newborn.

11. The hygiene hypothesis of the development of asthma proposes that:

• a. Babies not thoroughly cleaned up at birth are more likely to develop asthma.
• b. Viral infections in very young children make it less likely they will develop asthma.
• c. Adults who bathe infrequently are more likely to develop asthma.
• d. Frequent use of household cleaners can prevent the development of asthma.

12. People with asthma should watch what they ingest because:

• a. Some medicines and food preservative can trigger asthma attacks.
• b. Many foods will trigger asthma attacks.
• c. Unwashed foods frequently trigger asthma attacks.
• d. Soft drinks frequently trigger asthma attacks.

13. Coughing:

• a. Means that the asthmatic patient has been a smoker and probably also has COPD.
• b. Is unlikely during as asthma attack. Instead, it usually indicates a foreign body aspiration.
• c. Is a separate phenomenon from asthma attacks, and if it is persistent, it should be treated with cough medicine.
• d. Can be the only symptom of asthma in some people.

14. In young children:

• a. Wheezing usually indicates asthma.
• b. Wheezing usually indicates asthma, croup, or foreign body aspiration.
• c. Recurrent episodes of wheezing between ages 4 years and 6 years increase the likelihood that the child will eventually develop asthma.
• d. Unlike in adults, wheezing rarely accompanies asthma.

15. During as asthma attack, patients usually:

• a. Cannot completely empty their lungs of air.
• b. Cannot manage to take their rescue medicines.
• c. Cannot speak at all.
• d. Cannot sit up or stand.

16. Dyspnea:

• a. Means difficulty swallowing.
• b. Is a symptom unique to asthma.
• c. Is the sensation of inability to breathe sufficient amounts of air.
• d. Means coughing and wheezing.

17. People who have a genetic predisposition to develop allergies and allergic illnesses have:

• a. Atopy.
• b. Atrophy.
• c. Allotopy.
• d. Arthropy.

18. When auscultated, wheezing:

• a. Is always heard during an asthma attack.
• b. Is typically heard at only one spot during an asthma attack.
• c. Sounds musical and high-pitched.
• d. Sounds rough, wet, and rumbling or snoring.

19. When examining a patient with well-controlled asthma and who is not experiencing symptoms:

• a. You can always hear wheezing on auscultation.
• b. The chest x-ray shows a diffuse, ground-glass haziness throughout the lungs.
• c. The chest x-ray shows focal areas of consolidation in the lungs.
• d. The lung exam can be essentially normal.

20. The 1-second forced expiratory volume (FEV1) is:

• a. The rate at which all the air can be forcefully expelled from the lungs.
• b. The force with which all the air can be expelled from the lungs.
• c. The amount of air that can be forcefully expelled from the lungs.
• d. The amount of air that can be forcefully expelled from the lungs in 1 second.

21. The percent of the vital capacity that can be exhaled in 1 second (FEV1/FVC) usually:

• a. Goes up when a person has asthma.
• b. Goes up in all people as they age.
• c. Goes down when a person has asthma.
• d. Stays the same in all people as they age.

22. PEF, a measure of asthma control that can be determined at home, is an abbreviation for:

• a. Personal exhaustion factor.
• b. Peak expiratory flow.
• c. Power exhalation force.
• d. Personal-best expiratory force.

23. Lung function tests can be used to identify reversible obstructive lung disease by measuring the FEV1 before and after administering:

• a. A bronchodilator.
• b. Aspirin.
• c. Oxygen.
• d. An antibiotic.

24. Allergy testing is used to determine:

• a. How easily the patient's lymphocytes manufacture IgE to new substances (allergens).
• b. To which specific substances (allergens) the patient will have an allergic reaction.
• c. Whether certain viruses will mimic an allergic reaction in the patient.
• d. Whether exercise will mimic an allergic reaction in the patient.

25. Infants with intermittentwheezing are more likely to have or to develop asthma if a parent has a history of asthma.

• a. True
• b. False

26. One concern in very young children with asthma is that the disease may:

• a. Speed up their lung growth.
• b. Damage their vocal cords.
• c. Slow and interfere with their lung growth.
• d. Require a tonsillectomy.

27. Middle-aged or older adults who come to the ED with an exacerbation of COPD commonly have:

• a. Pulmonary emboli.
• b. Foreign-body aspiration.
• c. Allergies.
• d. Dyspnea.

28. An asthma attack in which the patient's PEF is 70–80% of their personal-best value is probably:

• a. Mild.
• b. Moderate.
• c. Severe.
• d. Extemely severe.

29. An asthma attack in which the patient's PEF is <25% of their personal-best value is probably:

• a. Mild.
• b. Moderate.
• c. Severe.
• d. Extremely severe.

30. One reason for giving patients a course of corticosteroids after an asthma attack is to:

• a. Protect against respiratory infections.
• b. Keep them from getting clinical depression.
• c. Reduce the chance of a recurrence.
• d. Keep blood sugar levels low during a period of stress.

31. Patients should begin their self-treatment of an asthma attack by quickly:

• a. Taking oral corticosteroids.
• b. Assessing the severity of the attack.
• c. Breathing warm humidified air from a steamer or a hot shower.
• d. Taking antibiotics.

32. For any level of severity of an attack, asthma patients should:

• a. Call 911 immediately.
• b. Drive themselves to the ED immediately.
• c. Take their rescue medicines.
• d. Immediately lie down and rest.

33. Symptoms during as asthma attack for which a patient does not have to call 911 immediately include:

• a. Inability to speak more than a few words at a time.
• b. Choking feeling and drowsiness.
• c. Sweating and extreme breathlessness.
• d. Still able to do normal activities and complete full sentences when speaking.

34. Recommended home treatments for an asthma attack include:

• a. Taking rescue medicines as soon as possible.
• b. Drinking large amounts of liquids.
• c. Breathing warm, moist air, such as from a hot shower.
• d. Using over-the-counter cold remedies.

35. For all asthma attacks presenting to the ED, the team should give:

• a. Intramuscular epinephrine.
• b. Oxygen, with a minimum goal of a blood oxygen saturation of >90%.
• c. A nonspecific beta-blocker.
• d. Oral theophylline (a methylxanthine).

36. One sign suggesting that intubation may be needed is a:

• a. Continually rising SaO₂.
• b. Continually falling SaO₂.
• c. Continually rising PEF.
• d. Stable PEF > 70% of the patient's predicted value.

37. When patients are discharged from the ED after an asthma attack:

• a. They will still have significant asthma symptoms.
• b. They should receive a brief educational counseling session.
• c. They will still be on supplemental oxygen.
• d. They should receive a prescription for epinephrine (Epipen).

38. Pharmacologic step therapy for asthma:

• a. Increases asthma patient's fitness with drugs and step exercises.
• b. Helps physicians prescribe long-term drugs with the minimal side effects.
• c. Tells patients how to step up rescue treatment during an asthma attack.
• d. Is based on increasing daily doses of methylxanthines (eg, theophylline).

39. To monitor the degree of long-term asthma control, clinicians should assess their patient's:

• a. Symptoms and lung function test values.
• b. Symptoms only.
• c. Lung function test values only.
• d. Exercise tolerance.

40. A beta2-agonist is a drug that:

• a. Decreases heart rate.
• b. Increases histamine release from mast cells.
• c. Reduces chronic inflammation.
• d. Relaxes muscles in the walls of lung airways.

41. Corticosteroids:

• a. Can only be used in an inhalable form.
• b. Are the best available long-term controllers for asthma.
• c. Increase inflammation.
• d. Are too dangerous for long-term use in asthma patients.

42. Prednisone is:

• a. A corticosteroid.
• b. A beta2-agonist.
• c. A methylxanthine.
• d. An anti-leukotriene.

43. Singulair, Accolate, and Zyflo are three relatively new asthma drugs that are:

• a. Leukotrienes.
• b. Anti-leukotrienes.
• c. Beta2-agonists.
• d. Expectorants.

44. Two asthma drugs, Intal and Tilade, target:

• a. Bronchial muscle and make it less responsive to histamine and other constrictor molecules.
• b. Mucus cells and make mucus secretion less copious.
• c. Mast cells and make them less likely to release inflammatory molecules.
• d. Epithelial cells and protect them from injury by air pollutants.

45. Nonpharmacologic tools for asthma:

• a. Can be equally important in controlling asthma.
• b. Are now of little use because anti-inflammatories can effectively control asthma.
• c. Have mainly psychological benefits.
• d. Are still vaguely defined and are not used by the top asthma clinics.

46. For asthma patients older than 6 months, yearly flu shots are:

• a. Potentially dangerous and not recommended.
• b. Recommended.
• c. Not dangerous but are not recommended.
• d. Optional because they are ineffective in most asthma patients.

47. For asthma relief, dust mite populations can be effectively reduced by:

• a. Using chemical pesticides.
• b. Adding protective rugs and carpets over concrete floors.
• c. Regular washing of bedding and dehumidification of the house.
• d. Using humidifiers and keeping the house warmer than usual.

48. Indoor mold can cause asthma symptoms, so the homes of asthma patients should be:

• a. Repainted.
• b. Fumigated with insecticides.
• c. Inspected and condemned if mold is found.
• d. Cleaned of mold and dehumidified.

49. Children's exposure to tobacco smoke at home:

• a. Is no longer a significant problem.
• b. Can be effectively avoided by having family members smoke outdoors.
• c. Is best dealt with by having social services remove the child from the home.
• d. Can trigger asthma and needs to be discussed with family members who smoke.

50. When your patient gets asthma symptoms in the workplace, it is always best to:

• a. Suggest legal action against the employer.
• b. Suggest relocation to another job in another city.
• c. Try immunotherapy.
• d. Work with the patient to protect them against possible reprisals.

51. Nonselective beta-blockers:

• a. Are drugs such as Tenormin, which is used mainly to treat cardiovascular conditions.
• b. Are drugs such as propranolol, which can cause bronchoconstriction.
• c. Are anticholinergic drugs, such as ipratropium bromide.
• d. Can be safely used by most asthma patients.

52. Exercise-induced asthma:

• a. Is life-threatening and patients with this problem should avoid all exercise.
• b. Can usually be prevented by exercising about once a month.
• c. Can usually be prevented by using a bronchodilator inhaler before exercising.
• d. Keeps an asthma patient from participating in competitive sports.

53. Pregnant women with asthma:

• a. Should stop their asthma medications during labor.
• b. Are at no higher risk of problem births than pregnant women without asthma.
• c. Should be extra conscious of the health of their fetus during asthma attacks and seek medical help quickly if fetal activity lessens.
• d. Can safely use nonselective beta-blockers, unlike other adults with asthma.

54. For most asthma patients, surgery:

• a. Should be avoided because intubation and general anesthesia are too dangerous.
• b. Is safe when the patients pass a preoperative asthma evaluation.
• c. Must only be done with local or regional anesthesia.
• d. Poses no higher risk of respiratory complications than for patients without asthma.