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Clinical Review Quiz

Management of Asthma in Children

Mutasim Abu-Hasan, MD, and Miles Weinberger, MD

Dr. Abu-Hasan is a clinical associate professor, and Dr. Weinberger
is a professor and Director, Pediatric Allergy and Pulmonary Division,
Children’s Hospital of Iowa, Iowa City, IA.

The questions below are based on the article
“Management of Asthma in Chillden:
Translating Patient-Oriented Evidence into Practice”.

Choose the single best answer for each question.

1. A 2-year-old toddler presents with a history of episodes of cough, wheezing, and increased work of breathing that are preceded by cold symptoms. He was hospitalized twice during the past winter but is healthy in between episodes and is asymptomatic during this evaluation. Which of the following is the most effective treatment for this toddler?
  1. Nebulized corticosteroids (ie, budesonide) twice daily
  2. High-dose inhaled corticosteroids daily via a valved holding chamber and mask
  3. Oral montelukast once daily
  4. On-hand oral corticosteroids to be given as early as possible after inception of symptoms and to be discontinued shortly after recovery
Click here to compare your answer.

2. A 3-year-old child with a history of chronic cough and wheezing suggestive of asthma presents for initial evaluation. Allergy skin testing will help in all of the following EXCEPT:

  1. Choosing among different maintenance medications
  2. Deciding on treatment periods
  3. Identifying potential triggers for asthma and correlating the pattern of symptoms with time of exposure to allergens
  4. Prognosis
Click here to compare your answer.

3. All of the following are short-acting ß2-agonists EXCEPT:

  1. Levalbuterol
  2. Pirbuterol
  3. Racemic albuterol
  4. Salmeterol
Click here to compare your answer.

4. Which of the following best describes the safety of long-acting ß2-agonists (LABAs) in conjunction with inhaled corticosteroids?

  1. Adding a LABA is safer than doubling the dose of inhaled steroids but requires careful monitoring for clinical consequences of possible ß-receptor downregulation
  2. LABAs are safe as a first-line treatment for moderate to severe asthma patients
  3. LABAs are safer than the use of montelukast as a steroid-sparing agent
  4. The dose of a LABA can be doubled for greater benefit
Click here to compare your answer .

5. Which of the following statements regarding valved holding chambers with metered-dose inhalers (MDI) is TRUE:

  1. They are not appropriate for infants
  2. They are more portable than a nebulizer but are more expensive
  3. They are as effective when used while a child is crying as during quiet breathing
  4. They provide more medication delivery to the lungs than the use of a MDI alone
Click here to compare your answer.

6.  During a follow-up visit of a child with chronic asthma, which of the following is least helpful in monitoring the course of the illness?

  1. Obtaining history of acute exacerbations
  2. Peak flow measurement
  3. Reviewing the symptom diary
  4. Spirometry
Click here to compare your answer.


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