NAECB Signs & Symptoms Of Asthma 5 — Questions and Answers
Question 1: Which occupational exposure is MOST commonly associated with work-related asthma symptoms that improve on weekends?
- Outdoor air pollution during commuting
- Sensitizers or irritants in the workplace such as isocyanates or flour dust (Correct answer)
- Tobacco smoke in public spaces
- Chlorine in municipal water supplies
Correct answer: Sensitizers or irritants in the workplace such as isocyanates or flour dust
Occupational asthma caused by workplace sensitizers like isocyanates (paint sprayers) or flour dust (bakers) classically improves on weekends away from exposure.
Question 2: Which symptom is considered a 'red flag' suggesting potential status asthmaticus?
- Mild wheeze that resolves after one puff of albuterol
- Cyanosis, inability to speak, or altered consciousness during an attack (Correct answer)
- Nighttime cough without daytime symptoms
- Seasonal rhinorrhea accompanying asthma symptoms
Correct answer: Cyanosis, inability to speak, or altered consciousness during an attack
Cyanosis, inability to speak, or altered mental status during an asthma attack indicate life-threatening status asthmaticus requiring immediate emergency intervention.
Question 3: Which pattern of eosinophilia would you MOST expect to find in a patient with allergic asthma?
- Neutrophilia in bronchoalveolar lavage only
- Peripheral blood and sputum eosinophilia (Correct answer)
- Normal eosinophil counts throughout
- Basophilia without eosinophil changes
Correct answer: Peripheral blood and sputum eosinophilia
Allergic asthma is characterized by type 2 inflammation with elevated eosinophils in both peripheral blood and induced sputum, reflecting IL-5–driven eosinophil production.
Question 4: A patient reports worsening asthma symptoms after starting a new blood pressure medication. Which drug class is MOST likely responsible?
- Calcium channel blockers
- Beta-blockers (Correct answer)
- ACE inhibitors causing wheeze
- Thiazide diuretics
Correct answer: Beta-blockers
Beta-blockers can precipitate severe bronchoconstriction in asthma patients by blocking beta-2 receptors that normally mediate airway smooth muscle relaxation.
Question 5: Which symptom pattern in children suggests asthma rather than viral bronchiolitis?
- First episode of wheeze in an infant under 12 months
- Recurrent episodes of wheeze triggered by multiple factors including exercise and allergens (Correct answer)
- Wheeze occurring only during RSV season
- Crackles and fever accompanying wheeze
Correct answer: Recurrent episodes of wheeze triggered by multiple factors including exercise and allergens
Recurrent wheeze triggered by multiple factors (allergens, exercise, cold air) in children over age 2 suggests asthma rather than isolated viral bronchiolitis.
Question 6: Which spirometric parameter directly reflects air trapping in a patient with uncontrolled asthma?
- Increased FVC
- Increased residual volume (RV) and functional residual capacity (FRC) (Correct answer)
- Decreased total lung capacity (TLC)
- Normal RV with reduced ERV
Correct answer: Increased residual volume (RV) and functional residual capacity (FRC)
Air trapping in asthma causes gas to accumulate in the lungs, elevating residual volume and functional residual capacity on full pulmonary function testing.
Question 7: During assessment of an asthma patient, which finding on peak flow monitoring suggests poor asthma control over the prior two weeks?
- Daily PEF consistently above 80% personal best with <10% variability
- PEF variability greater than 20% between morning and evening readings (Correct answer)
- PEF improving steadily each day without fluctuation
- Single PEF reading of 75% on one morning only
Correct answer: PEF variability greater than 20% between morning and evening readings
Diurnal PEF variability greater than 20% is a marker of airway hyperresponsiveness and indicates inadequate asthma control over the monitoring period.
NAECB Signs & Symptoms Of Asthma 5
Which occupational exposure is MOST commonly associated with work-related asthma symptoms that improve on weekends?