Bronchial Asthma MCQs – Hard Case Based Questions

1. A 22-year-old woman presents with episodic wheezing worse at night. Spirometry shows FEV₁ improvement of 18% after bronchodilator. Most likely diagnosis?

COPD Bronchial asthma Bronchiectasis Pulmonary fibrosis

Reversibility >12% strongly favors bronchial asthma.

2. A child with asthma worsens after taking aspirin. Mechanism involved?

Increased prostaglandins Leukotriene overproduction IgE suppression Histamine blockade

Aspirin inhibits COX → shunts arachidonic acid to leukotrienes.

3. A patient has asthma symptoms only during exercise. Best preventive drug?

Oral steroids Inhaled SABA before exercise Antibiotics Antihistamines

Exercise-induced asthma is prevented with pre-exercise SABA.

4. A severe asthma attack with silent chest indicates?

Mild asthma Improving asthma Life-threatening asthma Vocal cord dysfunction

Silent chest means minimal airflow – a medical emergency.

5. A patient needs daily SABA use. What does this indicate?

Well-controlled asthma Poor asthma control COPD overlap Drug allergy

Frequent SABA use indicates uncontrolled asthma.

6. A child with asthma has eczema and allergic rhinitis. This is known as?

Atopic triad Kartagener syndrome Churg-Strauss syndrome Goodpasture syndrome

Asthma + eczema + allergic rhinitis = atopic triad.

7. Best long-term controller drug in persistent asthma?

Oral beta blockers Inhaled corticosteroids Antibiotics Theophylline only

ICS is the cornerstone of asthma control.

8. A patient has nocturnal cough with normal chest X-ray. Most likely cause?

Lung cancer Cough variant asthma Pneumonia Tuberculosis

Cough variant asthma presents mainly with chronic cough.

9. In acute severe asthma, first-line therapy is?

Oral antibiotics Inhaled SABA + oxygen Antihistamines Diuretics

Rapid bronchodilation and oxygen are first priority.

10. A patient with asthma develops fixed airflow limitation due to?

Airway remodeling Infection Pleural effusion Atelectasis

Chronic inflammation leads to airway remodeling.

11. Which cell plays a key role in allergic asthma?

Neutrophils Eosinophils Platelets RBCs

Eosinophils drive allergic inflammation.

12. LABA should never be used alone because?

Causes hypoglycemia Increases asthma mortality Causes pneumonia Causes infection

LABA monotherapy increases asthma-related deaths.

13. Gold standard test to assess airflow reversibility?

Chest X-ray Spirometry ECG ABG

Spirometry confirms reversible obstruction.

14. Which immunoglobulin is elevated in allergic asthma?

IgA IgE IgG IgM

IgE mediates allergic asthma reactions.

15. Which drug blocks leukotriene receptors?

Montelukast Salbutamol Budesonide Ipratropium

Montelukast is a leukotriene receptor antagonist.

16. Nighttime symptoms suggest?

Well-controlled asthma Poor asthma control COPD only Anxiety disorder

Nocturnal symptoms indicate uncontrolled asthma.

17. Most common trigger of asthma?

Alcohol Allergens Fatty food Dehydration

Allergens are the most common triggers.

18. Which is NOT a feature of asthma?

Reversible obstruction Airway inflammation Progressive irreversible fibrosis early Bronchial hyperreactivity

Asthma is primarily reversible, unlike fibrosis.

19. Preferred route of asthma drug delivery?

Oral Intravenous Inhalational Intramuscular

Inhalation delivers drug directly to airways.

20. Which finding suggests severe asthma?

Normal speech Able to lie flat Inability to speak full sentences Normal pulse

Speech limitation indicates severe airflow obstruction.

Bronchial Asthma – 20 Hard MCQs (10 Case Based)