Case 7 Pharmacology - 20 Question SBA Challenge
SBA Questions
Q1. A 12-year-old with eosinophilic asthma is prescribed MART. Which drug combination is appropriate and
why?
A. Salbutamol + beclomethasone fast relief and steroid maintenance
B. Formoterol + budesonide rapid onset LABA + ICS
C. Salmeterol + fluticasone both slow onset
D. Tiotropium + budesonide anticholinergic + ICS
E. Montelukast + formoterol LTRA + LABA
Q2. A patient on regular salbutamol reports tremor and palpitations. What best explains this?
A. H1 antagonism
B. M3 blockade
C. 2 stimulation of skeletal and cardiac muscle
D. Mast cell degranulation
E. Elevated FeNO
Q3. Why is formoterol preferred over salmeterol in MART protocols?
A. It has a longer half-life
B. It is cheaper
C. It has a faster onset suitable for reliever use
D. It requires less monitoring
E. It is a steroid
Q4. An asthmatic child presents with tachycardia and hypokalaemia after overuse of reliever inhaler. What is
the cause?
A. Montelukast toxicity
B. Muscarinic receptor blockade
C. 2-agonist overdose
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Case 7 Pharmacology - 20 Question SBA Challenge
D. ICS side effects
E. Parasympathetic activation
Q5. Which of the following correctly pairs a drug with its receptor target?
A. Montelukast M3 antagonist
B. Beclomethasone glucocorticoid receptor agonist
C. Salbutamol 1 antagonist
D. Ipratropium 2 agonist
E. Omalizumab histamine receptor blocker
Q6. What is the primary mechanism of corticosteroids in asthma management?
A. Bronchodilation via 2 activation
B. Direct IgE neutralisation
C. Transcriptional repression of inflammatory cytokines
D. Chemokine receptor blockade
E. Mast cell membrane stabilisation
Q7. A patient with mild persistent asthma is started on montelukast. What is its mechanism?
A. 2 agonist
B. IgE blocker
C. Leukotriene receptor antagonist
D. M3 antagonist
E. H1 antagonist
Q8. Which of the following explains the benefit of using DPIs over pMDIs?
A. Greater peak expiratory effect
B. Higher corticosteroid dose
C. Lower environmental impact due to no propellants
D. Less effort required to use
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Case 7 Pharmacology - 20 Question SBA Challenge
E. Stronger bronchodilation
Q9. A patient treated with salmeterol alone experiences worsening asthma. Why?
A. Overactivation of 1 receptors
B. Inadequate anti-inflammatory effect without ICS
C. Corticosteroid resistance
D. Tachyphylaxis
E. Leukotriene excess
Q10. Why is tiotropium useful as add-on therapy in severe asthma?
A. 2 agonist effect
B. Leukotriene inhibition
C. Muscarinic M3 receptor blockade reducing bronchoconstriction
D. Glucocorticoid receptor activation
E. Mast cell stabilisation
Q11. Which asthma medication increases transcription of lipocortin-1 and reduces phospholipase A2 activity?
A. Salbutamol
B. Beclomethasone
C. Montelukast
D. Ipratropium
E. Salmeterol
Q12. A patient has poor control despite low-dose ICS. Whats the next NICE recommended step?
A. Start oral steroids
B. Switch to LTRA
C. Add LABA to ICS
D. Double the ICS dose
E. Stop ICS
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Case 7 Pharmacology - 20 Question SBA Challenge
Q13. Which of the following best explains how omalizumab works?
A. Blocks IL-5 directly
B. Inhibits histamine binding
C. Binds circulating IgE and prevents mast cell sensitisation
D. Enhances eosinophil apoptosis
E. Stimulates glucocorticoid receptor
Q14. Why are corticosteroids given in acute asthma exacerbation?
A. Stimulate bronchodilation
B. Enhance mucociliary clearance
C. Reduce airway inflammation and prevent late-phase response
D. Inhibit 2 desensitisation
E. Promote cough clearance
Q15. Which of the following would NOT be effective in eosinophilic asthma?
A. Anti-IL-5 therapy
B. Montelukast
C. Omalizumab
D. Anticholinergic
E. High-dose ICS
Q16. A patient with high FeNO is symptomatic despite ICS. What treatment is supported?
A. Stop all inhalers
B. Add montelukast
C. Step down therapy
D. Add LABA or increase ICS
E. Monitor only
Q17. In acute severe asthma, which is the most appropriate initial medication?
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Case 7 Pharmacology - 20 Question SBA Challenge
A. LABA inhaler
B. Inhaled corticosteroid
C. SABA via spacer or nebuliser
D. Oral montelukast
E. IV antihistamines
Q18. Why is regular SABA use discouraged in mild asthma?
A. It desensitises muscarinic receptors
B. It promotes leukotriene synthesis
C. It increases airway hyperresponsiveness and masking of inflammation
D. It causes eosinopenia
E. It reduces mucosal barrier
Q19. Which of the following drugs should be prescribed for exercise-induced asthma?
A. Inhaled corticosteroid only
B. SABA 1015 min before exercise
C. LABA monotherapy
D. Omalizumab
E. LTRA post-exercise
Q20. What is the mechanism of muscarinic antagonists in asthma?
A. Bronchoconstriction via M1 stimulation
B. Inhibition of M3 receptor reducing vagally mediated bronchospasm
C. Enhanced IL-5 release
D. Direct mast cell stabilisation
E. 1 blockade
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Case 7 Pharmacology - 20 Question SBA Challenge
Answers and Explanations
Q1 Answer: B
Explanation: Formoterol has rapid onset and is suitable for both maintenance and reliever use when
combined with budesonide.
Q2 Answer: C
Explanation: Salbutamol stimulates 2 receptors in skeletal and cardiac muscle, causing tremor and
tachycardia.
Q3 Answer: C
Explanation: Formoterol's fast onset makes it appropriate for MART, unlike salmeterol.
Q4 Answer: C
Explanation: Overuse of 2 agonists like salbutamol can cause hypokalaemia and tachycardia.
Q5 Answer: B
Explanation: Beclomethasone acts on glucocorticoid receptors; others are mismatches.
Q6 Answer: C
Explanation: Corticosteroids inhibit transcription of inflammatory mediators via glucocorticoid receptor
binding.
Q7 Answer: C
Explanation: Montelukast blocks leukotriene D4 at the cysteinyl leukotriene receptor.
Q8 Answer: C
Explanation: DPIs avoid the use of propellants found in pMDIs, reducing environmental impact.
Q9 Answer: B
Explanation: LABA alone can worsen asthma outcomes without ICS due to unchecked inflammation.
Q10 Answer: C
Explanation: Tiotropium blocks muscarinic M3 receptors, reducing bronchoconstriction.
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Case 7 Pharmacology - 20 Question SBA Challenge
Q11 Answer: B
Explanation: Beclomethasone upregulates lipocortin-1, which inhibits phospholipase A2 and reduces
inflammation.
Q12 Answer: C
Explanation: NICE recommends adding a LABA to ICS if asthma is not controlled on ICS alone.
Q13 Answer: C
Explanation: Omalizumab binds to free IgE, preventing interaction with mast cells and basophils.
Q14 Answer: C
Explanation: Steroids reduce inflammation and suppress the late-phase response in exacerbations.
Q15 Answer: D
Explanation: Anticholinergics are not primarily effective in eosinophilic-driven inflammation.
Q16 Answer: D
Explanation: FeNO is a marker of Th2 inflammation; next step is to increase ICS or add LABA.
Q17 Answer: C
Explanation: First-line in acute severe asthma is a SABA via spacer or nebuliser for rapid bronchodilation.
Q18 Answer: C
Explanation: Regular SABA use may mask symptoms and worsen underlying inflammation and
hyperresponsiveness.
Q19 Answer: B
Explanation: SABA before exercise can prevent bronchospasm in exercise-induced asthma.
Q20 Answer: B
Explanation: Muscarinic antagonists reduce vagally mediated bronchospasm by blocking M3 receptors.
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