ASTHMA
Certification Exam
Actual Questions and Answers
100% Guarantee Pass.
This Exam contains:
100% Guarantee Pass.
Actual Questions and Answers
Multiple choice (single best answer)
Case Studies/Scenario-Based Questions
Verified Rationales
,An 18-year-old female presents to your office with a history of wheezing and year-
round symptoms of rhinitis. She reports wheezing and coughing several times a week
but rarely more than once a day, except in the last year, when she has had to
intermittently use albuterol (Proventil, Ventolin) every day for a week at a time. She
wakes up with nighttime coughing weekly, without fever or other symptoms, and tells
you this tends to scare her cat, who sleeps with her. Albuterol helps her symptoms
temporarily. She has been treated with oral corticosteroids on three occasions this
past year, most recently 6 weeks ago. Her Asthma Control Test score is 17. Pre- and
post-bronchodilator spirometry results are shown below.
Initial testing
FVC............2.0 L (80% of predicted)
FEV1............1.4 L (70% of predicted)
FEF 25-75............1.5 L/sec (89% of predicted)
15 minutes post bronchodilator administration
FVC............2.3 L (105% of predicted)
FEV1............2.0 L (100% of predicted)
FEF 25-75............1.9 L/sec (100% of predicted)
Appropriate management at this time includes which of the following? (Mark all that
are true.)
A. Initiation of inhaled formoterol (Foradil) and an inhaled corticosteroid
,B. Albuterol, 1-2 puffs as needed
C. A discussion about removing the cat from her bedroom
D. Follow-up in 2 months
**Answer**
A, B, C
*Rationale:*
This patient has moderate persistent asthma. She should begin an inhaled
corticosteroid and a long-acting β-adrenergic agent. She should also have a short-
acting β-adrenergic inhaler available for use on an as-needed basis. The patient
should also be counseled about removing the cat from the room. Follow-up should
occur 2-5 weeks after initiating therapy.
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True statements regarding the use of long-acting β2-agonists in asthma include which
of the following? (Mark all that are true.)
A. They are useful for treating acute symptoms or exacerbations
B. They represent an alternative to inhaled corticosteroids in patients with persistent
asthma
C. They provide a mild anti-inflammatory effect
, D. They are beneficial when used in conjunction with inhaled corticosteroids
E. Salmeterol (Serevent) acts more rapidly than formoterol (Foradil)
**Answer**
D
*Rationale:*
Long-acting β2-agonists can be used in patients with persistent asthma to provide
sustained symptom control, particularly for nocturnal or exercise-induced symptoms.
Because of their relatively slow onset of action and time to peak effect, they should
not be used for acute symptom relief. Because they do not have a significant anti-
inflammatory effect, they should be used with another controller medication, such as
an inhaled corticosteroid, in patients with persistent asthma. The onset of
bronchodilation occurs in 2-3 minutes with formoterol, as opposed to 10-15 minutes
with salmeterol. Given the possibility of excess mortality noted in the Salmeterol Multi-
center Asthma Research Trial (SMART), long-acting β2-agonists should be added only
when inhaled corticosteroids or other controller medications have failed to control the
asthma.
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A 14-year-old female presents to you with a recent history of cough and shortness of
breath with exercise. Baseline pulmonary function testing reveals an FEV1 of 3.1 L and
a PEF of 600 L/min. Exercise testing is scheduled.