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AE-C practice questions

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Question 1Assessment and Monitoring of Asthma

Which spirometry measurement is used to confirm airflow obstruction?

  1. FVC
  2. FEV1 percent predicted
  3. FEV1/FVC ratio Correct answer.
  4. Peak expiratory flow

Explanation

Airflow obstruction is defined by a reduced FEV1/FVC ratio below the lower limit of normal or less than 0.70 in adults. FEV1 percent predicted is used to grade severity once obstruction is present, not to confirm obstruction.

Question 2Assessment and Monitoring of Asthma

In adults, which post-bronchodilator FEV1 change meets the standard criterion for significant reversibility?

  1. Increase of ≥10% and ≥150 mL
  2. Increase of ≥12% and ≥200 mL Correct answer.
  3. Increase of ≥20% and ≥500 mL
  4. Increase of ≥5% and ≥100 mL

Explanation

A significant bronchodilator response in adults is an increase in FEV1 of at least 12% and at least 200 mL from baseline. Both the percentage and absolute volume criteria must be met.

Question 3Assessment and Monitoring of Asthma

A 28-year-old with asthma scores 18 on the Asthma Control Test. How should this score be interpreted?

  1. Not well controlled Correct answer.
  2. Invalid
  3. Well controlled
  4. Completely controlled

Explanation

The Asthma Control Test totals range from 5 to 25, with higher scores indicating better control. A score of 19 or less indicates that asthma is not well controlled and should prompt review of treatment.

Question 4Assessment and Monitoring of Asthma

A patient's personal best peak expiratory flow is 500 L/min. Which range represents the green zone?

  1. 300 to 399 L/min
  2. 200 to 299 L/min
  3. 400 to 500 L/min Correct answer.
  4. 100 to 199 L/min

Explanation

The green zone corresponds to 80% to 100% of the personal best peak flow. For a personal best of 500 L/min, this is 400 to 500 L/min.

Question 5Assessment and Monitoring of Asthma

Which tool is validated for assessing asthma control in children aged 4 to 11 years?

  1. ACQ
  2. PEF diary
  3. C-ACT Correct answer.
  4. ACT

Explanation

The Childhood Asthma Control Test (C-ACT) is validated for children aged 4 to 11 years and incorporates child and caregiver responses. The standard Asthma Control Test is used in patients aged 12 years and older.

Question 6Assessment and Monitoring of Asthma

In adults, which FEV1/FVC value is generally considered normal?

  1. ≥0.70 Correct answer.
  2. ≥0.85
  3. ≥0.60
  4. ≥0.50

Explanation

A post-bronchodilator FEV1/FVC ratio of 0.70 or greater is generally considered normal in adults. Values below this threshold suggest airflow obstruction, although the lower limit of normal is more precise.

Question 7Assessment and Monitoring of Asthma

Once a patient is receiving treatment, asthma severity is classified according to which factor?

  1. Number of night awakenings per week
  2. Treatment intensity needed to control symptoms and exacerbations Correct answer.
  3. Frequency of daytime symptoms at diagnosis
  4. FEV1 percent predicted alone

Explanation

Severity is assessed retrospectively from the intensity of treatment required to maintain symptom control and prevent exacerbations. Symptom frequency and lung function contribute to control assessment but do not alone define severity in a treated patient.

Question 8Assessment and Monitoring of Asthma

Which measurement best reflects the variable nature of airflow limitation in asthma?

  1. FVC
  2. Diffusing capacity for carbon monoxide
  3. Diurnal peak flow variability Correct answer.
  4. Single pre-bronchodilator FEV1

Explanation

Asthma is characterized by variable airflow limitation, and diurnal peak flow variability captures this fluctuation over time. A single FEV1 provides a snapshot and does not demonstrate variability.

Question 9Assessment and Monitoring of Asthma

Spirometry in a 35-year-old shows FEV1/FVC 0.62, FEV1 68% predicted, and a post-salbutamol FEV1 rise of 15% and 250 mL. Which interpretation is most appropriate?

  1. Reversible obstruction Correct answer.
  2. Normal spirometry
  3. Restrictive defect
  4. Fixed obstruction

Explanation

The low FEV1/FVC ratio establishes obstruction, and the post-bronchodilator rise meets the 12% and 200 mL reversibility criterion. Together these findings indicate reversible airflow obstruction.

Question 10Assessment and Monitoring of Asthma

A symptomatic patient with normal spirometry has a methacholine PC20 of 4 mg/mL. What does this result most suggest?

  1. Positive challenge Correct answer.
  2. Normal responsiveness
  3. Fixed obstruction
  4. Restrictive disease

Explanation

A methacholine PC20 below 8 mg/mL indicates bronchial hyperresponsiveness and supports a diagnosis of asthma in a symptomatic patient. Normal spirometry does not exclude asthma.

Question 11Assessment and Monitoring of Asthma

An adult nonsmoker with asthma has a fractional exhaled nitric oxide of 60 ppb. What does this value most likely indicate?

  1. No inflammation
  2. Eosinophilic inflammation Correct answer.
  3. Fixed obstruction
  4. Bacterial infection

Explanation

FeNO is a noninvasive marker of eosinophilic airway inflammation, and values above 50 ppb in adults are considered high. This finding supports corticosteroid-responsive inflammation.

Question 12Assessment and Monitoring of Asthma

What is the minimal clinically important difference for the Asthma Control Test total score?

  1. 3 points Correct answer.
  2. 5 points
  3. 1 point
  4. 10 points

Explanation

A change of 3 points on the Asthma Control Test is considered the minimal clinically important difference. Smaller changes may not reflect meaningful clinical improvement or worsening.

Question 13Assessment and Monitoring of Asthma

An Asthma Control Questionnaire score of 1.6 is best interpreted as which level of control?

  1. Totally controlled
  2. Well controlled
  3. Not well controlled Correct answer.
  4. Indeterminate

Explanation

An ACQ score of 1.5 or greater indicates inadequate asthma control. A score of 1.6 therefore falls in the not-well-controlled range.

Question 14Assessment and Monitoring of Asthma

Which item completes the GINA four-question symptom control assessment over the past 4 weeks: daytime symptoms, night waking, reliever use, and ___?

  1. Morning peak flow reading
  2. FEV1 percent predicted
  3. Activity Correct answer.
  4. Sputum eosinophils

Explanation

GINA assesses four symptom domains in the past 4 weeks: daytime symptoms, night waking, reliever use, and activity limitation. Lung function and inflammatory markers are assessed separately.

Question 15Assessment and Monitoring of Asthma

An adult in the emergency department with acute asthma speaks in single words, has SpO2 89% on room air, and a heart rate of 130/min. How should the exacerbation be classified?

  1. Mild
  2. Moderate
  3. Exercise-induced bronchospasm
  4. Severe Correct answer.

Explanation

Severe exacerbations are characterized by inability to speak in sentences, oxygen saturation below 90%, and heart rate above 120/min in adults. This patient meets those criteria.

Question 16Assessment and Monitoring of Asthma

Which blood eosinophil threshold is commonly used to identify eosinophilic asthma in adults?

  1. ≥150 cells/µL
  2. ≥50 cells/µL
  3. ≥300 cells/µL Correct answer.
  4. ≥100 cells/µL

Explanation

A blood eosinophil count of 300 cells/µL or higher is commonly used to identify eosinophilic asthma and predicts a greater likelihood of corticosteroid responsiveness. Lower thresholds are used in some contexts but are not the standard cutoff.

Question 17Assessment and Monitoring of Asthma

For spirometry to be acceptable in adults, the two largest FEV1 values and the two largest FVC values should agree within what volume?

  1. 250 mL
  2. 500 mL
  3. 50 mL
  4. 150 mL Correct answer.

Explanation

Reproducibility is acceptable when the two largest FEV1 values and the two largest FVC values are within 150 mL of each other. At least three acceptable maneuvers are also required.

Question 18Assessment and Monitoring of Asthma

Which instruction is correct for home peak flow monitoring in asthma?

  1. Measure once weekly, at any time of day
  2. Measure twice daily before reliever use Correct answer.
  3. Measure after reliever use each morning
  4. Measure only during symptoms, with one effort

Explanation

Home peak flow should be measured twice daily, before bronchodilator use, and the best of three efforts recorded. This helps detect diurnal variability and early deterioration.

Question 19Assessment and Monitoring of Asthma

Which FEV1 percent predicted value is associated with a markedly increased risk of asthma exacerbations?

  1. 85%
  2. 75%
  3. 55% Correct answer.
  4. 95%

Explanation

An FEV1 below 60% predicted is a recognized risk factor for exacerbations and should prompt closer monitoring. Values above 80% predicted carry lower risk.

Question 20Assessment and Monitoring of Asthma

A sputum eosinophil count of 5% in a patient with asthma indicates which finding?

  1. Neutrophilic inflammation
  2. Bacterial pneumonia
  3. Normal finding
  4. Eosinophilic inflammation Correct answer.

Explanation

Sputum eosinophilia of 3% or greater indicates eosinophilic airway inflammation, which is common in asthma and predicts corticosteroid response. A value of 5% is therefore abnormal.

Question 21Assessment and Monitoring of Asthma

A methacholine challenge yields a PC20 of 12 mg/mL in a symptomatic adult. How should this be interpreted?

  1. Definite asthma
  2. Normal response
  3. Severe AHR
  4. Borderline AHR Correct answer.

Explanation

A PC20 between 8 and 16 mg/mL is considered borderline airway hyperresponsiveness. Values below 8 mg/mL are positive, and values above 16 mg/mL are generally normal.

Question 22Assessment and Monitoring of Asthma

A 60-year-old smoker with asthma has FEV1/FVC 0.58 and a post-bronchodilator FEV1 change of 100 mL (6%). What is the best interpretation?

  1. Restrictive pattern
  2. Significant reversibility
  3. Fixed obstruction Correct answer.
  4. Normal spirometry

Explanation

The low FEV1/FVC ratio indicates obstruction, but the post-bronchodilator change does not meet the 12% and 200 mL criterion. The pattern is therefore obstruction without significant reversibility.

Question 23Assessment and Monitoring of Asthma

In adults, a FeNO value greater than 50 ppb is best classified as which level?

  1. Low
  2. Intermediate
  3. Indeterminate
  4. High Correct answer.

Explanation

Adult FeNO values below 25 ppb are low, 25 to 50 ppb are intermediate, and values above 50 ppb are high. High values support eosinophilic inflammation.

Question 24Assessment and Monitoring of Asthma

On the Asthma Control Test, how is each of the five items scored?

  1. 0 to 3
  2. 0 to 10
  3. 1 to 5 Correct answer.
  4. 1 to 4

Explanation

Each Asthma Control Test item is scored from 1 to 5, and the five items are summed for a total of 5 to 25. Higher item and total scores indicate better control.

Question 25Assessment and Monitoring of Asthma

A 6-year-old with acute asthma has SpO2 of 91% on room air and cannot complete a sentence in one breath. How should the exacerbation be classified?

  1. Not an exacerbation
  2. Severe Correct answer.
  3. Moderate
  4. Mild

Explanation

In children, oxygen saturation below 92% and inability to speak in sentences indicate a severe exacerbation. These findings require urgent treatment.

Question 26Assessment and Monitoring of Asthma

In a patient recording peak expiratory flow twice daily, which degree of diurnal variability is most consistent with poorly controlled asthma?

  1. Between 5% and 10%
  2. Less than 5%
  3. More than 20% Correct answer.
  4. A single reading below 80% of predicted

Explanation

Diurnal peak flow variability above about 20% reflects variable airflow limitation and supports a diagnosis of poorly controlled asthma. Variability is calculated from morning and evening readings collected over one to two weeks.

Question 27Assessment and Monitoring of Asthma

An adult completes the Asthma Control Test and scores 18. How should this score best be interpreted?

  1. Not well-controlled asthma Correct answer.
  2. Well-controlled asthma
  3. Very poorly controlled asthma
  4. The score cannot be interpreted without spirometry

Explanation

The Asthma Control Test ranges from 5 to 25, with 20-25 indicating well-controlled asthma, 16-19 indicating not well-controlled asthma, and 5-15 indicating very poorly controlled asthma. A score of 18 therefore falls in the not well-controlled band.

Question 28Assessment and Monitoring of Asthma

Which oxygen saturation range is appropriate for an adult receiving oxygen during an acute asthma exacerbation?

  1. 93% to 95% Correct answer.
  2. 90% to 92%
  3. 85% to 90%
  4. 98% to 100%

Explanation

Guidelines recommend titrating supplemental oxygen in acute asthma to a saturation of about 93-95% in adults. This corrects hypoxaemia while avoiding unnecessary high-flow oxygen.

Question 29Assessment and Monitoring of Asthma

Fractional exhaled nitric oxide testing in asthma is used primarily to assess which of the following?

  1. Eosinophilic airway inflammation Correct answer.
  2. Small airways obstruction
  3. Bronchial hyperresponsiveness
  4. Respiratory muscle strength

Explanation

Exhaled nitric oxide is a non-invasive marker of type 2, eosinophil-driven airway inflammation. It does not measure airflow obstruction, bronchial responsiveness, or muscle strength.

Question 30Assessment and Monitoring of Asthma

How often should inhaler technique be assessed in a patient with asthma?

  1. Once, when the device is first prescribed
  2. At every clinical review Correct answer.
  3. Annually at the routine check
  4. Only when asthma control deteriorates

Explanation

Poor inhaler technique is common and is a frequent cause of treatment failure, so technique should be observed and corrected at every opportunity. A single demonstration at initiation is not sufficient because skills decay over time.

Question 31Assessment and Monitoring of Asthma

In which situation is a chest radiograph most clearly indicated in a patient with asthma?

  1. Suspected pneumothorax during an exacerbation Correct answer.
  2. Routine annual review of mild asthma
  3. Well-controlled asthma on low-dose inhaled corticosteroid
  4. Before starting a leukotriene receptor antagonist

Explanation

Imaging is not routine in asthma but is indicated when a complication or alternative diagnosis is suspected, such as pneumothorax, pneumonia, or foreign body. Suspected pneumothorax during an exacerbation is a clear indication.

Question 32Assessment and Monitoring of Asthma

For standard bronchodilator reversibility testing in an adult, spirometry is repeated how long after inhalation of salbutamol 400 micrograms?

  1. 5 minutes
  2. 60 minutes
  3. 2 to 3 minutes
  4. 10 to 15 minutes Correct answer.

Explanation

Reversibility testing is typically performed 10-15 minutes after 400 micrograms of salbutamol given by spacer or nebuliser. This interval allows the bronchodilator effect to plateau while remaining practical in the laboratory.

Question 33Assessment and Monitoring of Asthma

Which finding is an absolute contraindication to performing a methacholine bronchial challenge?

  1. An FEV1 of 85% of predicted
  2. A history of allergic rhinitis
  3. An FEV1 below 50% of predicted Correct answer.
  4. Current use of an inhaled corticosteroid

Explanation

Methacholine challenge is contraindicated when baseline FEV1 is below about 50% of predicted or below 1 litre, because of the risk of severe bronchoconstriction. Inhaled corticosteroids and allergic rhinitis are not contraindications.

Question 34Assessment and Monitoring of Asthma

A current cigarette smoker with asthma has a fractional exhaled nitric oxide of 14 ppb. How does smoking affect interpretation of this result?

  1. Smoking lowers FeNO and may mask inflammation Correct answer.
  2. Smoking raises FeNO and may exaggerate inflammation
  3. Smoking has no measurable effect on FeNO values
  4. Smoking makes FeNO uninterpretable in all patients

Explanation

Cigarette smoke acutely suppresses exhaled nitric oxide, so a low value in a smoker can underestimate underlying eosinophilic inflammation. The result remains interpretable but must be read with the smoking history in mind.

Question 35Assessment and Monitoring of Asthma

The Childhood Asthma Control Test is validated for which age group?

  1. 4 to 11 years Correct answer.
  2. 6 to 14 years
  3. 12 to 17 years
  4. 2 to 4 years

Explanation

The Childhood Asthma Control Test is designed for children aged 4 to 11 years and combines child-completed and caregiver-completed items. Adolescents aged 12 and over use the adult Asthma Control Test.

Question 36Assessment and Monitoring of Asthma

Before sputum induction in a patient with asthma, which precaution is recommended?

  1. Perform the test immediately after exercise
  2. Withhold all inhaled corticosteroids for 48 hours
  3. Give a sedative to reduce coughing
  4. Premedicate with an inhaled bronchodilator Correct answer.

Explanation

Inhaled hypertonic saline can provoke bronchoconstriction, so a short-acting bronchodilator is given beforehand and FEV1 is checked during the procedure. Sedation and exercise before the test are not part of the protocol.

Question 37Assessment and Monitoring of Asthma

Which monitoring is specifically recommended for children receiving long-term inhaled corticosteroids for asthma?

  1. Regular measurement of height and growth velocity Correct answer.
  2. Annual chest radiography
  3. Monthly blood eosinophil counts
  4. Routine measurement of serum cortisol

Explanation

Inhaled corticosteroids can slow growth velocity, so height should be measured and plotted regularly in children on long-term treatment. Other systemic effects are monitored clinically rather than by routine laboratory testing.

Question 38Assessment and Monitoring of Asthma

Which method is most practical for estimating adherence to inhaled corticosteroids over the past year in routine practice?

  1. Pharmacy prescription refill records Correct answer.
  2. Asking the patient whether they take their inhaler
  3. Counting doses left in one inhaler at the visit
  4. A single measurement of exhaled nitric oxide

Explanation

Dispensing records provide an objective, longitudinal estimate of how much medication was actually obtained and can be converted into a proportion of prescribed doses. Self-report overestimates adherence and a single inhaler count reflects only a short window.

Question 39Assessment and Monitoring of Asthma

Which element is essential in a written asthma action plan?

  1. A list of all previously tried inhaler devices
  2. The patient's most recent spirometry printout
  3. When and how to increase treatment and seek help Correct answer.
  4. A fixed lifelong dose of oral corticosteroid

Explanation

An action plan must give the patient concrete instructions on recognising deterioration and on when and how to step up treatment or seek urgent care. Device history, raw spirometry output, and fixed steroid doses do not serve this purpose.

Question 40Assessment and Monitoring of Asthma

A patient with typical asthma symptoms has normal spirometry and no significant bronchodilator response. Which test is most appropriate next to support the diagnosis?

  1. Repeat spirometry after 6 months
  2. A chest radiograph
  3. Serum total IgE measurement
  4. A bronchial provocation challenge Correct answer.

Explanation

When spirometry is normal and reversibility is absent but symptoms suggest asthma, a bronchial provocation challenge is the appropriate confirmatory test. A negative methacholine challenge has high negative predictive value, while a positive result demonstrates hyperresponsiveness.

Question 41Assessment and Monitoring of Asthma

A patient with a severe asthma exacerbation has an arterial PaCO2 of 50 mmHg (6.7 kPa). What does this finding indicate?

  1. Impending respiratory failure Correct answer.
  2. Mild exacerbation with appropriate hyperventilation
  3. A normal compensatory response to bronchospasm
  4. Improved gas exchange compared with baseline

Explanation

In acute severe asthma the PaCO2 is usually low because of hyperventilation. A normal or rising PaCO2 signals tiring of the respiratory muscles and impending ventilatory failure, requiring urgent escalation of care.

Question 42Assessment and Monitoring of Asthma

Peak flow diaries show a mean morning value of 400 L/min and a mean evening value of 300 L/min. Using the amplitude-over-mean method, what is the diurnal variability?

  1. About 14%
  2. About 25%
  3. About 29% Correct answer.
  4. About 33%

Explanation

Amplitude-over-mean variability is the difference between the highest and lowest values divided by their mean, multiplied by 100. Here (400 - 300) / 350 x 100 is approximately 29%.

Question 43Assessment and Monitoring of Asthma

After 3 months of inhaled corticosteroid treatment, a patient's methacholine PC20 rises from 1 mg/mL to 4 mg/mL. How is this best interpreted?

  1. Airway responsiveness has worsened
  2. The patient has developed tolerance to methacholine
  3. Airway hyperresponsiveness has improved Correct answer.
  4. The result is unchanged within measurement error

Explanation

PC20 is the concentration of methacholine producing a 20% fall in FEV1, so a higher value means less responsive airways. A rise from 1 to 4 mg/mL represents a two doubling-dose improvement, consistent with a good response to anti-inflammatory treatment.

Question 44Assessment and Monitoring of Asthma

A worker reports worsening breathlessness on workdays. Which peak flow pattern best supports a diagnosis of occupational asthma?

  1. Readings are consistently above personal best on workdays
  2. Readings fall steadily and remain low on days away from work
  3. Readings fall during work periods and improve on days away from work Correct answer.
  4. Readings are lowest in the early morning on all days

Explanation

Occupational asthma is supported by a temporal relationship in which peak flows deteriorate during exposure at work and recover when the patient is away from the workplace. Serial readings over several weeks, including rest days, are needed to show this pattern.

Question 45Patient and Family Education and Counseling

Which of the following medications is a short-acting beta2-agonist used for quick relief of acute asthma symptoms?

  1. Albuterol Correct answer.
  2. Tiotropium
  3. Fluticasone
  4. Montelukast

Explanation

Short-acting beta2-agonists such as albuterol relax airway smooth muscle within minutes and are the standard quick-relief medicines for acute symptoms. The other agents listed provide long-term control of inflammation or bronchoconstriction rather than immediate relief.

Question 46Patient and Family Education and Counseling

A patient using a fluticasone metered-dose inhaler is taught to rinse the mouth and spit after each dose primarily to reduce the risk of which problem?

  1. Dental caries
  2. Vocal cord paralysis
  3. Oral candidiasis Correct answer.
  4. Gastroesophageal reflux

Explanation

Inhaled corticosteroid deposited in the mouth and throat can suppress local immune defenses and allow overgrowth of Candida, causing thrush or hoarseness. Rinsing and spitting after each dose removes that residue and lowers the risk.

Question 47Patient and Family Education and Counseling

A peak flow meter is used to measure which of the following?

  1. Forced vital capacity
  2. Peak expiratory flow rate Correct answer.
  3. Oxygen saturation
  4. Minute ventilation

Explanation

A peak flow meter records how fast air can be blown out of the lungs, reported as peak expiratory flow rate in liters per minute. Readings are effort dependent, so consistent technique matters more than any single value.

Question 48Patient and Family Education and Counseling

On a standard three-zone written asthma action plan, the green zone indicates that the patient's asthma is:

  1. unstable and warrants an urgent call to the clinician
  2. well controlled and the usual daily regimen should continue Correct answer.
  3. severe and requires immediate emergency care
  4. worsening and requires the reliever inhaler every hour

Explanation

Green signals that symptoms and peak flow are at the patient's usual good level, so routine controller and reliever instructions apply. Yellow and red zones progressively describe worsening control and escalating actions.

Question 49Patient and Family Education and Counseling

A valved holding chamber attached to a metered-dose inhaler is primarily recommended because it:

  1. increases the dose delivered with each actuation
  2. removes the need to shake the inhaler before use
  3. converts a dry powder formulation into a metered-dose aerosol
  4. improves delivery to the lungs and reduces drug left in the mouth and throat Correct answer.

Explanation

A holding chamber slows the aerosol so large particles settle out and the patient can inhale the finer particles that reach the airways, reducing oropharyngeal deposition and local side effects. It also reduces the coordination needed to use an inhaler.

Question 50Patient and Family Education and Counseling

The teach-back method is best described as:

  1. asking the patient to explain or demonstrate the teaching in their own words Correct answer.
  2. repeating the same instructions more loudly until the patient agrees
  3. quizzing the patient on the medical terminology used in the handout
  4. giving the patient a printed handout and obtaining a signature confirming receipt

Explanation

Teach-back confirms comprehension by having the learner restate or show the skill rather than merely confirming that something was said. It shifts responsibility for clarity onto the educator and reveals specific misunderstandings.