1. A 23-year-old male has a history of asthma and presented to the ER with SOB & wheezing. At ER, they started O2 supplementation. What is the best step to do for this patient to take him out of this exacerbation state?

• Albuterol
• Anticholinergic drug
• Steroid
• Pulmonary function tests

2. A 31-year-old obese female with a history of asthma comes to your OPD complaining of severe shortness of breath and wheezing. She produces from her purse a number of active medications including a beclomethasone metered dose inhaler (MDI) and salmeterol MDI. She also appears to be taking zafirlukast daily. She tells you that she has been hospitalised many times for asthma flares and was once intubated. Her review of systems is pertinent for asthma attacks of increasing severity over the past few weeks but she denies any fever, cough, chills, or pleuritic chest pain. On exam, the patient demonstrates audible expiratory wheezes with a markedly prolonged expiratory time. Her respiratory rate is 20-24/min and she is acutely short of breath, using accessory muscles of respiration to breathe. Her vital signs are otherwise stable. Which of the following is the most beneficial management of this patient?

• Obtain a chest radiograph to rule out pneumonia
• Albuterol nebuliser therapy in the office
• Refer the patient to the local hospital for admission
• Refer the patient to the local emergency room for evaluation and treatment

3. What is the function of mast cells?

1. Control of releasing adrenaline
2. Control of releasing antihistamine
3. Control of releasing histamine

• C only
• A and B
• B and C
• A and C

4. The patient who has asthma is experiencing frequent coughs and chest tightness. You auscultate the patient’s lung fields and note expiratory wheezes. The patient’s peak flow rate is 78% less than their best peak flow reading. Which medication will provide the patient with the fastest relief from these signs and symptoms of an asthma attack?

• Theophylline
• Tiotropium
• Albuterol
• Cromolyn

5. You’re providing discharge teaching to a patient who was admitted with asthma. You discussed the early warning signs of an asthma attack and ask the patient to list some of them. Select all the correct early warning signs verbalised by the patient.

• Reduced peak flow meter reading
• Wheezing with activity
• Nighttime coughing
• All of the above