ASTHMA

(MCQ/CHOSE THE BEST

ONE WITH EXPLANATION)
1. A 12-yr-old asthmatic boy has developed an asthma exacerbation in the past few days.
Asthma symptoms have continued to progress despite frequent albuterol use at home. He
comes to the emergency department with chest tightness, dyspnea, and wheezing, and in
moderate respiratory distress. In this setting, management should include all of the
following except:

a) Close monitoring
b) Supplemental oxygen
c) Inhaled albuterol
d) Theophylline
e) Systemic glucocorticoids

2. Complications of intravenous immunoglobulin (IVIG) therapy include all of the

following except:

a) Anaphylaxis
b) Fluid overload
c) Transmission of HIV
d) Aseptic meningitis
e) Systemic reactions

3. A 1-yr-old child is found to have a normal WBC count but no circulating B cells, small
tonsils, and no palpable lymph nodes. Serum concentrations of IgG, IgA, IgM, and IgE
are below the 95% lower limits for age. The most likely diagnosis is:

a) Ataxia-telangiectasia
b) X-linked lymphoproliferative syndrome
c) DiGeorge syndrome
d) Common variable immunodeficiency
e) X-linked agammaglobulinemia

4. A 1-mo-old infant develops bloody diarrhea associated with fever. The most
likely agent causing this illness is:

a) Nontyphoidal Salmonella
b) Shigella
c) Campylobacter
d) Yersinia
e) Rotavirus

5. A 20-mo-old child develops hemolytic anemia, anuria, azotemia, and

thrombocytopenia after a bout of febrile bloody diarrhea. The most likely etiologic agent
of this illness is:

a) Campylobacter jejuni
b) Salmonella typhi
c) Enterohemorrhagic Escherichia coli
d) Aeromonas
e) Non-typhi Salmonella
6. A 1-mo-old female infant is presented with a chief complaint of poor feeding and
lethargy. Parents report that the child was well until 3 days earlier, when poor feeding
began. Pulse rate is 280 beats/min, respiratory rate is 50/min, and blood pressure is 80/50
mm Hg. Physical examination shows a gallop rhythm and an enlarged liver palpable 2-3
cm below the right costal margin. The most appropriate diagnostic test for this patient
would be:

a) Chest radiograph
b) CBC
c) ECG
d) ABG analysis
e) Blood culture

7. A newborn is found to have congenital heart block. Which of the following is the most
likely etiology?

a) Group B streptococcal infection

b) Neonatal echovirus infection
c) Gestational diabetes
d) Maternal lupus
e) Gray baby syndrome

8. Presenting manifestations of pheochromocytoma may include:

a) Sustained hypertension
b) Abdominal pain
c) Polyuria and polydipsia
d) Weight loss
e) All of the above
Answer Key:

1. D
2. D
3. E
4. A
5. C
6. C
7. D
8. E
 1.
Which of the following are risk factors for the development
of asthma?

A.

High exposure to airborne allergens

B.

Exposure to tobacco smoke

C.

High birth weight

D.

Genetic factors
Correct Answer(s)
A. High exposure to airborne allergens
B. Exposure to tobacco smoke
D. Genetic factors
Explanation
Exposure to airborne allergens, exposure to tobacco smoke, and genetic
factors are all risk factors for the development of asthma. High
exposure to airborne allergens can trigger asthma symptoms in
individuals who are already susceptible to the condition. Exposure to
 tobacco smoke can irritate the airways and increase the risk of
developing asthma. Genetic factors play a role in determining an
individual's susceptibility to asthma, as it can be passed down through
family members. High birth weight, however, is not considered a risk
factor for asthma development.
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 2.
Susceptibility for asthma is primarily determined in
adulthood (around 20-25 years of age)

A.

True

B.

False
Correct Answer
B. False
Explanation
Susceptibility for asthma is not primarily determined in adulthood.
Asthma is a chronic condition that can develop at any age, including
childhood. While some individuals may develop asthma later in life, it
is not solely determined in adulthood. Genetic factors, environmental
exposures, and other factors can contribute to the development of
asthma at any age.
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 3.
What are some adult-onset risk factors for the development
of asthma?

A.

Occupational exposure to irritants

B.

Alcohol consumption

C.

Smoking

D.

Obesity

E.

Hormonal influences

F.

Exposure to pollutants and infectious agents

 Correct Answer(s)
A. Occupational exposure to irritants
C. Smoking
D. Obesity
E. Hormonal influences
F. Exposure to pollutants and infectious agents
Explanation
Adult-onset asthma is a form of asthma that develops in adulthood,
typically after the age of 20. The risk factors mentioned in the answer
are known to contribute to the development of adult-onset asthma.
Occupational exposure to irritants, such as chemicals or dust, can
trigger asthma symptoms in adults. Smoking, both active and passive,
is a well-known risk factor for asthma. Obesity is also associated with
an increased risk of developing asthma in adulthood. Hormonal
influences, such as changes in estrogen levels, can play a role in the
development of asthma. Lastly, exposure to pollutants and infectious
agents can also contribute to the development of adult-onset asthma.
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 4.
Asthma is characterized by chest tightness, wheezing,
sputum production, cough, and airway hyperresponsiveness.
What other factor is also a characteristic?

A.

Irreversible lower airway constriction

B.

Persistent symptoms
 o

C.

Reversible lower airway constriction

D.

Symptoms are the same for every person with asthma

Correct Answer
C. Reversible lower airway constriction
Explanation
Reversible lower airway constriction is a characteristic of asthma. This
means that the narrowing of the airways in the lungs can be reversed
with appropriate treatment. This is different from irreversible lower
airway constriction, which would indicate that the narrowing cannot be
fully reversed. Persistent symptoms are also a characteristic of asthma,
but the specific characteristic being asked for in this question is the
reversible nature of the lower airway constriction. Symptoms are not
the same for every person with asthma, as they can vary in severity and
presentation.
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 5.
Which definition best suits the term "inflammation" in
relation to asthma?

A.
 Inflammation is caused by infectious agents in asthma and is
mediated by antiproteases

B.

Inflammation is associated with airway remodeling in asthma.

Inflammation is triggered by a stimulus and causes epithelial
injury, among other things

C.

Inflammation is caused by airway remodeling in asthma.

D.

Mast cells can help to reduce inflammation by releasing

histamine and preventing further lung damage.
Correct Answer
B. Inflammation is associated with airway remodeling in asthma.
Inflammation is triggered by a stimulus and causes epithelial injury,
among other things
Explanation
The correct answer explains that inflammation in relation to asthma is
associated with airway remodeling. It states that inflammation is
triggered by a stimulus and causes epithelial injury, among other
things. This suggests that inflammation in asthma leads to changes in
the structure of the airways and can cause damage to the epithelial cells
lining the airways.
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 6.
There are two phases in extrinsic asthma, the
_______________ and ______________ phases
Correct Answer
early, late
Explanation
Extrinsic asthma is characterized by two distinct phases, the early and
late phases. In the early phase, an immediate allergic response occurs
when the individual is exposed to an allergen. This leads to the release
of inflammatory mediators, such as histamine, causing symptoms like
wheezing, coughing, and shortness of breath. The late phase follows the
early phase and is characterized by a prolonged inflammatory response.
During this phase, additional inflammatory cells are recruited to the
airways, leading to further airway narrowing and persistent symptoms.
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 7.
Which of the following are characteristics of extrinsic
asthma?

A.

Airway hyperresponsiveness

B.

IgE hypersensitivity mediation

o
 C.

Exercise mediation

D.

Allergy mediation
Correct Answer(s)
A. Airway hyperresponsiveness
B. IgE hypersensitivity mediation
D. Allergy mediation
Explanation
Extrinsic asthma is characterized by airway hyperresponsiveness,
which means that the airways in the lungs are easily irritated and
constrict in response to certain triggers. This type of asthma is also
associated with IgE hypersensitivity mediation, where the immune
system overreacts to allergens, causing inflammation and narrowing of
the airways. Additionally, extrinsic asthma is often triggered by
allergies, such as pollen, dust mites, or pet dander, leading to symptoms
such as wheezing, coughing, and shortness of breath.
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 8.
Which of the following are characteristics of intrinsic
asthma?

A.

Exercise is a trigger

o
 B.

Cold air is a trigger

C.

Allergy mediated

D.

Hormonal changes are triggers

Correct Answer(s)
A. Exercise is a trigger
B. Cold air is a trigger
D. Hormonal changes are triggers
Explanation
Intrinsic asthma is a type of asthma that is not caused by allergies. It is
characterized by triggers such as exercise, cold air, and hormonal
changes. These triggers can lead to symptoms such as wheezing,
coughing, and shortness of breath. Unlike extrinsic asthma, which is
caused by allergies, intrinsic asthma is not triggered by allergens.
Instead, it is triggered by factors such as physical activity, exposure to
cold air, and hormonal fluctuations. Therefore, the correct
characteristics of intrinsic asthma are that exercise, cold air, and
hormonal changes can all act as triggers for asthma symptoms.
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 9.
Airway remodeling is a major player in the pathology of
asthma.
 o

A.

True

B.

False
Correct Answer
A. True
Explanation
Airway remodeling refers to the structural changes that occur in the
airways of individuals with asthma. These changes can include
thickening of the airway walls, increased smooth muscle mass, and
excessive production of mucus. These alterations contribute to the
long-term progression and severity of asthma symptoms. Therefore, it
is accurate to say that airway remodeling is a significant factor in the
pathology of asthma.
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 10.
Which statement is false regarding airway remodeling?

A.

There is an increase in goblet cells and mucus production

B.
 Thickened smooth muscle cells with hyperplasia and
hypertrophy

C.

Decreased collagen deposition in airways

D.

Increased vascularity in the airway wall

Correct Answer
C. Decreased collagen deposition in airways
Explanation
There is actually an increase in collagen and other protein deposition.
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 11.
Airway remodeling can be seen in young children with
asthma.

A.

True

B.

False
 Correct Answer
A. True
Explanation
Airway remodeling refers to the structural changes that occur in the
airways of individuals with asthma over time. These changes can
include thickening of the airway walls, increased smooth muscle mass,
and excessive mucus production. While airway remodeling is typically
associated with long-standing and severe asthma, research has shown
that even young children with asthma can exhibit signs of airway
remodeling. This suggests that the structural changes in the airways can
occur early in the disease process and highlights the importance of
early intervention and appropriate management of asthma in children.
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 12.
Which of the following statements is false regarding the
early phase of extrinsic asthma?

A.

It occurs within 10-20 minutes of triggering stimuli exposure

B.

The allergen binds to IgE receptors on the surface of airways

and activates mast cells

C.
 Decreased mucus secretion, leading to less airway protection,
occurs

D.

Increased vascular permeability and bronchoconstriction

occur
Correct Answer
C. Decreased mucus secretion, leading to less airway protection, occurs
Explanation
During the early phase of extrinsic asthma, several physiological
changes occur in the airways. These include increased vascular
permeability and bronchoconstriction, which lead to inflammation and
narrowing of the airways. Additionally, the allergen triggers the
binding of IgE receptors on the surface of airways, activating mast cells
and releasing inflammatory mediators. However, decreased mucus
secretion does not occur during the early phase of extrinsic asthma. In
fact, mucus production usually increases as a protective response to the
inflammation and irritation in the airways.
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 13.
Which of the following is false regarding the late phase of
an extrinsic asthma event?

A.

Occurs within 4-8 hours of the trigger and may persist for
days/weeks

o
 B.

Inflammatory mediators cause the recruitment of WBCs, such

as neutrophils, eosinophils, basophils, and lymphocytes

C.

Macrophages are activated

D.

Decreased airway responsiveness occurs

Correct Answer
D. Decreased airway responsiveness occurs
Explanation
During the late phase of an extrinsic asthma event, there is actually an
increased airway responsiveness rather than a decreased one. This is
because the inflammatory mediators released during this phase cause
the airway smooth muscles to contract, leading to narrowing of the
airways and increased resistance to airflow. This increased airway
responsiveness contributes to the symptoms of asthma such as
wheezing, shortness of breath, and coughing.
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 14.
Which inflammatory mediators are released when mast cells
degranulate and after degranulation?

A.
 Histamine

B.

Leukotrienes

C.

Prostaglandin D2

D.

Chemotactic chemokines

E.

Dopamine

F.

Antiproteases

G.

TNFa
 Correct Answer(s)
A. Histamine
B. Leukotrienes
C. Prostaglandin D2
D. Chemotactic chemokines
G. TNFa
Explanation
When mast cells degranulate, they release various inflammatory
mediators. Histamine is one of the mediators released, which causes
vasodilation and increased vascular permeability. Leukotrienes are also
released, which are lipid mediators that promote inflammation and
bronchoconstriction. Prostaglandin D2 is another mediator released,
which has pro-inflammatory effects. Chemotactic chemokines are
released to attract immune cells to the site of inflammation. TNFa, or
tumor necrosis factor alpha, is a cytokine released by mast cells that
promotes inflammation and can induce cell death.
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 15.
What are some symptoms that clients with asthma may
encounter?

A.

Dyspnea/SOB

B.

Chest tightness

o
 C.

Cough

D.

Quiet breathing

E.

Wheezing
Correct Answer(s)
A. Dyspnea/SOB
B. Chest tightness
C. Cough
E. Wheezing
Explanation
Clients with asthma may experience symptoms such as dyspnea
(shortness of breath) and SOB (shortness of breath), chest tightness,
cough, and wheezing. These symptoms are commonly associated with
asthma and can vary in severity from mild to severe. Dyspnea and SOB
refer to difficulty in breathing or feeling breathless, chest tightness is a
sensation of pressure or discomfort in the chest, cough can be persistent
and may worsen at night or with physical activity, and wheezing is a
high-pitched whistling sound produced during breathing. These
symptoms can be triggered by various factors including allergens,
exercise, cold air, and respiratory infections.
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 16.
 During an asthma attack, air becomes trapped with impaired
function, and _______________ ensues. Alveolar
______________ occurs due to increasing interpleural and
alveolar gas pressure. _________________ is triggered.
___________/perfusion mismatch occurs. First alkalosis
occurs due to decreased _________ concentration in the
blood, but the resulting hypoventilation eventually causes
______________. Respiratory failure can result.
Correct Answer(s)
hyperinflation, hypoventilation, Hyperventilation, Ventilation, CO2,
Acidosis
Explanation
During an asthma attack, air becomes trapped with impaired function,
and hyperinflation ensues. Alveolar hypoventilation occurs due to
increasing interpleural and alveolar gas pressure. Hyperventilation is
triggered. Ventilation/perfusion mismatch occurs. First alkalosis occurs
due to decreased CO2 concentration in the blood, but the resulting
hypoventilation eventually causes acidosis. Respiratory failure can
result.
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 17.
Which of the following are clinical SIGNS of asthma?

A.

Shortness of breath

B.
 Wheezing heard on auscultation

C.

Vital signs such as tachypnea decreased 02 sats

D.

Chest tightness

E.

Increased work of breathing observed

F.

In the ability to maintain a conversation with the healthcare

provider
Correct Answer(s)
B. Wheezing heard on auscultation
C. Vital signs such as tachypnea decreased 02 sats
E. Increased work of breathing observed
F. In the ability to maintain a conversation with the healthcare provider
Explanation
The clinical signs of asthma include wheezing heard on auscultation,
vital signs such as tachypnea (rapid breathing) and decreased oxygen
saturation levels, increased work of breathing observed, and the ability
to maintain a conversation with the healthcare provider. These signs
indicate the presence of respiratory distress and narrowing of the
 airways, which are characteristic of asthma. Shortness of breath and
chest tightness are symptoms of asthma rather than clinical signs, as
they are subjective experiences reported by the patient.
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 18.
During the initial stage of an asthma attack, respiratory
______________ occurs in the blood. After a period of time
without enough 02, the respiratory ____________ occurs.
Correct Answer(s)
alkalosis, acidosis
Explanation
During the initial stage of an asthma attack, there is an increase in the
respiratory rate, leading to hyperventilation. This causes a decrease in
the concentration of carbon dioxide (CO2) in the blood, resulting in
respiratory alkalosis. However, if the asthma attack persists and the
person is unable to get enough oxygen (O2), the body will switch to
anaerobic metabolism, leading to an increase in the concentration of
CO2 in the blood. This results in respiratory acidosis.
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 19.
What are some things that may be seen on a chest x-ray of
someone with asthma?

A.

Under inflation of the lower lobes

o
 B.

Enlarged heart

C.

Hyperinflation

D.

Increase or decrease flattening in the hemidiaphragms

Correct Answer(s)
C. Hyperinflation
D. Increase or decrease flattening in the hemidiaphragms
Explanation
On a chest x-ray of someone with asthma, hyperinflation may be seen.
This refers to an abnormal increase in the size of the lungs, indicating
air trapping and difficulty in exhaling. Additionally, an increase or
decrease in flattening of the hemidiaphragms may be observed. The
hemidiaphragms are the muscles that separate the chest cavity from the
abdominal cavity, and their flattening can be a sign of increased air
pressure in the lungs. These findings are characteristic of asthma and
can help in diagnosing and monitoring the condition.
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 20.
Which of the following is false about lung spirometry tests?

A.
 They are used in the initial diagnosis and to evaluate
treatment

B.

Their red zone is less than 90% of the expected value

C.

They are used with bronchial provocation tests

D.

They evaluate the function of the lungs

Correct Answer
B. Their red zone is less than 90% of the expected value
Explanation
Lung spirometry tests are used in the initial diagnosis and to evaluate
treatment, they are used with bronchial provocation tests, and they
evaluate the function of the lungs. However, the statement that is false
is that their red zone is less than 90% of the expected value. In
spirometry tests, the red zone typically represents a value below 60% or
80% of the predicted or expected value, indicating severe impairment.
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 21.
Which of the following is long-term pharmacotherapy for
asthma?
 o

A.

Anticholinergics

B.

Systemic corticosteroids

C.

Mast cell stabilizers

D.

Inhaled corticoid steroids

Correct Answer(s)
C. Mast cell stabilizers
D. Inhaled corticoid steroids
Explanation
Mast cell stabilizers and inhaled corticoid steroids are considered long-
term pharmacotherapy for asthma. Mast cell stabilizers, such as
cromolyn sodium, work by preventing the release of inflammatory
substances from mast cells, reducing airway inflammation and
preventing asthma symptoms. Inhaled corticosteroids, such as
fluticasone and budesonide, are the most effective long-term control
medications for asthma. They work by reducing airway inflammation
and suppressing the immune response, helping to prevent asthma
attacks and improve overall asthma control. Systemic corticosteroids
 are typically used for short-term relief of severe asthma symptoms,
while anticholinergics are used as a bronchodilator to relax the airway
muscles.
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 22.
Which of the following is shorting acting pharmacotherapy
for asthma?

A.

Short broncodilaters

B.

Monoclonal antibody therapy

C.

Anticholinergics

D.

Systemic corticosteroids
Correct Answer(s)
A. Short broncodilaters
C. Anticholinergics
D. Systemic corticosteroids
 Explanation
Short-acting bronchodilators, anticholinergics, and systemic
corticosteroids are all considered short-acting pharmacotherapy options
for asthma. Short-acting bronchodilators, such as albuterol, provide
quick relief by relaxing the muscles around the airways.
Anticholinergics, like ipratropium, also help relax the airway muscles
and can be used as a short-term treatment for asthma symptoms.
Systemic corticosteroids, such as prednisone, are used for short periods
to reduce inflammation and improve asthma control. These medications
are typically used in combination with long-term control medications
for asthma management.
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 23.
Which of the following is NOT a characteristic of asthma?

A.

Increase in IgG immunoglobulins

B.

Airway hyperresponsiveness

C.

Infiltration of eosinophils into the airways

o
 D.

Increased mucus production

Correct Answer
A. Increase in IgG immunoglobulins
Explanation
Asthma is a chronic inflammatory disease of the airways that is
characterized by airway hyperresponsiveness, infiltration of eosinophils
into the airways, and increased mucus production. IgG
immunoglobulins are not typically associated with asthma. IgE
immunoglobulins, on the other hand, play a significant role in the
pathophysiology of asthma by triggering an allergic response and
causing inflammation in the airways. Therefore, an increase in IgG
immunoglobulins is not a characteristic of asthma.