1. Sternocleidomastoid muscle retractions can be a reliable indicator of significant obstruction. Other factors that should be considered include all of the following except:

• a. Increased respiratory rate.
• b. Use of accessory muscles.
• c. Intercostal and abdominal retractions.
• d. Decreased respiratory rate.

2. “Crackles and wheezing” heard on auscultatory exam can be associated with all of the following except:

• a. Asthma.
• b. Pneumonia.
• c. Congestive heart failure.
• d. Upper respiratory infections.

3. Chest radiography may be of benefit in asthmatic children in whom you suspect:

• a. Foreign-body obstruction.
• b. Viral etiology.
• c. Allergic etiology.
• d. Congestive heart failure.

4. As many as _______ of high school athletes have exercised induced asthma.

• a. One-tenth
• b. One-third
• c. One-half
• d. It is very rarely seen in high-school athletes

5. Initial treatment for exercised-induced asthma includes:

• a. Cromolyn.
• b. Leukotriene immune modifiers.
• c. Beta-2 agonists and inhaled corticosteroids.
• d. Antihistamines.

6. The degree of obstruction in the pediatric patient is determined by:

• a. Peak inspiratory flow rates (PIFR).
• b. Peak inspiratory/expiratory volume.
• c. Peak expiratory flow rate (PEFR).
• d. Peak expiratory/inspiratory flow rate.

7. The following is correct about PEFR testing in asthmatic children:

• a. You can perform it in all age groups.
• b. Perform the test three times, then use the lowest measurement before and after treatment.
• c. Perform the test three times, then use the highest of the three measurements before and after treatment.
• d. PEFR does not correlate with FEV1 (forced expiratory volume in 1 second).

8. The advantages of using the Pulmonary Score for assessing asthma severity include all of the following except:

• a. It has undergone validation trials.
• b. It does not include the cumbersome inspiratory-expiratory ratio.
• c. It correlates with the PEFR in mild-to-severe exacerbations.
• d. It does not use the respiratory rate dependent on age.

9. In general it is useful to remember that an O₂ saturation of 90% on pulse oximetry corresponds to a PaO₂ of:

• a. 40 mm Hg
• b. 60 mm Hg
• c. 80 mm Hg
• d. 90 mm Hg

10. For pulse oximetry to be accurate, the following is necessary:

• a. The arterial pulse must be detected in the extremity.
• b. The child must weigh more than 10 kg
• c. The extremity should be cold.
• d. Pulse oximeters should not be used with children.

11. The partial pressure of CO₂ from a capillary blood gas level (PcCO₂) is often _________ than the arterial level (PaCO₂).

• a. Higher
• b. Lower
• c. The same
• d. Variable—(higher or lower)

12. End-tidal CO₂ cannot accurately be used to assess CO₂ levels in asthma because:

• a. The device is not approved for children under 12.
• b. Airway obstruction and rapid respiratory rate prevents movement of CO₂ in the upper airways.
• c. You cannot measure CO₂ with O₂ prongs in the nose.
• d. Studies have shown that it is not necessary to measure CO₂ in children.

13. S-albuterol has been found to:

• a. Have powerful bronchodilating effects.
• b. Decrease airway reactivity.
• c. Cause “paradoxic bronchospasm.”
• d. B and C are correct.

14. Normal PaCO₂ in the presence of tachypnea in an asthmatic patient:

• a. Indicates that there is adequate ventilation.
• b. May be an early sign of impending respiratory failure.
• c. Has no clinical significance.
• d. Is unrelated to muscle fatigue.

15. Consideration of obtaining ABGs in pediatric asthmatic patients is recommended in all of the following situations except:

• a. Persistent O₂ saturations of less than 90% on maximal O₂ therapy.
• b. Failure to improve despite aggressive treatment.
• c. Mental status changes.
• d. Oxygen saturations greater than 90% on O₂ therapy.

16. The pathophysiology of asthma can be summed up as being due to:

• a. Bronchoconstriction without inflammation.
• b. Inflammation only.
• c. Bronchoconstriction and inflammation.
• d. Infection with inflammation.

17. In a mildly distressed pediatric patient, oral prednisone:

• a. Has little effect in reducing inflammation.
• b. Tastes so bad that children often vomit.
• c. Steroids are not used in children.
• d. Should be given IV.

18. Repeated courses of steroids in children have been found to:

• a. Have no adverse effects on bone or adrenal function.
• b. Cause adrenal suppression in a majority.
• c. Cause growth retardation in a majority.
• d. Cause increased infection rates in a majority.

19. Continuous or back-to-back levalbuterol treatments have been shown to be:

• a. Associated with unwanted side effects and are not recommended.
• b. The mainstay of the therapy of status asthmaticus.
• c. No more productive of side effects than single treatment but they are no more effective.
• d. Should not be used in children under 5 years old.

20. Ipratropium bromide has an effect in asthmatics by:

• a. Reducing secretions.
• b. Blocking acetylcholine receptors and causing bronchodilation.
• c. Blocking inflammatory pathways.
• d. Blocking serotonin receptors and causing bronchodilation.

21. In a crashing pediatric patient terbutaline is given at this dose:

• a. 100 mug/kg and followed by a drip of 0.1mug/kg/min
• b. 50 mug/kg and followed by a drip of 0.1mug/kg/min
• c. 10 mug/kg and followed by a drip of 0.2mug/kg/min
• d. 200 mug/kg and followed by a drip of 2mug/kg/min

22. Heliox (helium:oxygen mixture) has been found to be beneficial in asthmatic due to its:

• a. Ability to bronchodilate.
• b. Anti-inflammatory properties.
• c. Ability to allow more oxygen to pass through a narrow airway.
• d. Turbulence when passing through a narrow airway.

23. Absolute indications for intubation include all of the following except:

• a. Respiratory failure.
• b. Apnea.
• c. Inability to speak.
• d. Coma.