Asthma

A 5 year old AA male comes in with a history of asthma, but currently is not on any medication.  In the history, you find out he uses his Albuterol MDI  with spacer once every two weeks during the day.  He does wake up 2-3 times per week coughing at night.  How would you classify his asthma?

• A.

  Intermittent

• B.

  Mild Persistent

• C.

  Moderate Persistent

• D.

  Severe Persistent

What is the definition of wheezing?

An 8 year-old boy who has had asthma since the age of 2 presents with increasing frequent cough and shortness of breath for the past 3 months.  He was being treated with low-dose inhaled corticosteroid and albuterol inhalations.  His symptoms occur daily, they worsen when he plays soccer, and they wake him at night 3 to 4 times per week.  Which is the best course of action at this time?

• A.

  Continue current regimen while suspending playing soccer until symptoms improve

• B.

  Increase the frequency of albuterol inhalations to every 4 hours

• C.

  Increase inhaled corticosteroid therapy to medium-dose

• D.

  Start on sodium cromolyn inhalations prior to playing soccer

A 7 year-old girl is treated for severe persistent asthma with high-dose inhaled corticosteroids along with a long-acting beta agonist and montelukast.  Which of the following is the most important to monitor during follow-up visits?

• A.

  Bone mineral density

• B.

  Fasting blood glucose

• C.

  Subcapsular cataracts

• D.

  Rate of increase in height

What percentage of infants and young children who have wheezing with viral infections will develop asthma?

• A.

  5%

• B.

  40%

• C.

  80%

• D.

  100%

Which of the following is not an appropriate reason to refer an asthma patient to an asthma specialist?

• A.

  After initial diagnosis of intermittent asthma

• B.

  Difficulties controlling asthma

• C.

  A patient now requires step 4 care (severe persistent asthma)

• D.

  A patient now requires step 3 care (moderate persistent asthma)

Which of the following is NOT a risk factor for the development of asthma?

• A.

  Parental history of asthma

• B.

  Physician diagnosed atopic dermatitis

• C.

  Peripheral eosinophilia and allergic rhinitis

• D.

  Wheezing apart from colds and allergic rhinitis

• E.

  Recurrent otitis media

True/False:  Gastroesophageal reflux should be considered in a patient who has poorly controlled asthma, with a significant nocturnal component.

• A.

  True

• B.

  False

Tru/False:  If a patient has had coughing or wheezing for over one year, the possiblity of a foreign body is essentially ruled out.

• A.

  True

• B.

  False

A 6 year-old girl is brought in for evaluation of nighttime cough and wheezing after being exposed to secondhand smoke.  A pulmonary function test using a forced expiratory maneuvar to display a flow-volume curve is ordered.  Which of the following regarding PFT is true in this situation?

• A.

  Flattening of the inspiratory portion of the flow volume loop and decreased forced vital capacity suggest asthma

• B.

  Increase in FEV1 by at least 12% after bronchodilator administration is indicative of asthma

• C.

  PFT assessment in those younger than age 8 is unreliable due to lack of patient cooperation