COPD

Question 1

The physiologic marker of COPD

Answer 1

Airflow obstruction

Question 2

Hallmark of COPD

Answer 2

Extensive small airway obstruction

Question 3

Principal component of elastic fibers.
Critical for lung integrity.

Answer 3

Elastin

Question 4

____ in COPD may worsen oxidative stress

Answer 4

Mitochondrial dysfunction

Question 5

The major site of increased resistance in most individuals with COPD is in airways </= 2mm diameter

Answer 5

Small airways

Question 6

Cough and mucus production

Answer 6

Chronic bronchitis

Question 7

Characterized by destruction of gas-exchanging structures:
Respiratory bronchioles.
Alveolar ducts.
Alveoli.

Answer 7

Emphysema

Question 8

Type of emphysema most frequently associated with cigarette smoking

Answer 8

Centrilobular

Question 9

Centrilobular emphysema is usually most prominent in the ____

Answer 9

upper lobes
superior segment of lower lobes

Question 10

Type of emphysema seen in α1-Antitrypsin Deficiency.

Answer 10

Panlobular

Question 11

Type of emphysema distributed along pleural margins.
Relative sparing of lung core/central regions.

Answer 11

Paraseptal

Question 12

The classic definition of COPD

Answer 12

persistent reduction in forced expiratory flow rates.

Question 13

Volume of air exhaled in the first second of forced expiration.

Answer 13

FEV1

Question 14

Total volume of air exhaled during the spirometric maneuver.

Answer 14

FVC

Question 15

FEV₁/FVC Ratio is ____ in COPD

Answer 15

reduced

Question 16

COPD shows ____ in FEV₁ with inhaled bronchodilators (≤15%).

Answer 16

minimal improvement

Question 17

PaCO₂ (Arterial Carbon Dioxide Pressure):
elevation typically not seen until FEV₁ <__% of predicted.

Answer 17

25

Question 18

PaO₂ (Arterial Oxygen Pressure):
remains near normal until FEV₁ <__% of predicted.

Answer 18

50

Question 19

______ accounts for essentially all of the reduction in Pao 2 that occurs in COPD

Answer 19

Ventilation-perfusion mismatching

Question 20

____ was a major risk factor for mortality from chronic bronchitis and emphysema

Answer 20

Cigarette smoking

Question 21

______ is the most highly significant predictor of FEV 1

Answer 21

Pack-years of cigarette smoking

Question 22

Individuals with ___ Z alleles or ___ Z and ____ null allele are referred to as PiZ , which is the most common form of severe α 1 AT deficiency.

Answer 22

two
one
one

Question 23

The three most common symptoms in COPD are ___

Answer 23

cough, sputum production, and exertional dyspnea.

Question 24

Signs of hyperinflation include a ____

Answer 24

barrel chest and enlarged lung volumes with poor diaphragmatic excursion as assessed by percussion.

Question 25

Some patients with advanced disease have paradoxical inward movement of the rib cage with inspiration

Answer 25

Hoover’s sign

Question 26

In COPD patients, the development of _____ is the most likely explanation for newly developed clubbing

Answer 26

lung cancer

Question 27

The hallmark of COPD is ____

Answer 27

airflow obstruction

Question 28

The degree of ____is an important prognostic factor in COPD and is the basis for the GOLD spirometric severity classification

Answer 28

airflow obstruction

Question 29

It has been shown that a multifactorial index _____ is a better predictor of mortality.

Answer 29

(BODE) body mass index, airflow obstruction, dyspnea, exercise performance

Question 30

An elevated ___ in ABG suggests the presence of chronic hypoxemia, as does the presence of signs of right ventricular hypertrophy.

Answer 30

hematocrit

Question 31

CXR: Increased lung volumes, flattened diaphragm.

Answer 31

Hyperinflation

Question 32

CXR: Bullae, hyperlucency, paucity of parenchymal markings.

Answer 32

Emphysema

Question 33

______ is the current definitive test for establishing the presence or absence of emphysema, the pattern of emphysema, and the presence of significant disease involving medium and large airways

Answer 33

Chest CT scan

Question 34

Smokers with COPD are at high risk for development of ____

Answer 34

lung cancer

Question 35

Recent guidelines have suggested testing for _____ in all subjects with COPD or asthma with chronic airflow obstruction.

Answer 35

α1 AT deficiency

Question 36

Triple Inhaled Therapy: Components:

Answer 36

Long-acting beta agonist (LABA) bronchodilator. Long-acting muscarinic antagonist (LAMA) bronchodilator. Inhaled corticosteroid (ICS).

Question 37

In general, _____ are the primary treatment for almost all patients with COPD and are used for symptomatic benefit and to reduce exacerbations

Answer 37

bronchodilators

Question 38

The most frequent side effect of muscarinic antagonist

Answer 38

Dry mouth

Question 39

The most frequent side effect of beta agonists

Answer 39

tremor tachycardia

Question 40

The main role of ____is to reduce exacerbations.

Answer 40

ICS

Question 41

Use of inhaled corticosteroids has been associated with increased rates of ____ and pneumonia and in some studies an increased rate of _____ and development of cataracts.

Answer 41

oropharyngeal candidiasis loss of bone density

Question 42

____ is the only pharmacologic therapy demonstrated to unequivocally decrease mortality in patients with COPD.

Answer 42

Supplemental O2

Question 43

Resting hypoxemia (resting O2 saturation ___% in any patient or ___% with signs of pulmonary arterial hypertension, right heart failure or erythrocytosis)

Answer 43

≤88 ≤89

Question 44

This refers to a comprehensive t ment program that incorporates exercise, education, and psychosocial and nutritional counseling.

Answer 44

Pulmo Rehab

Question 45

Patients with ____ lobe–predominant emphysema and a low postrehabilitation exercise capacity are most likely to benefit from LVRS.

Answer 45

upper

Question 46

____ is currently the second leading indication for lung transplantation.

Answer 46

COPD

Question 47

The strongest single predictor of exacerbations is ____

Answer 47

a history of a previous exacerbation.

Question 48

Other factors, such as an ___ and ____, are also associated with increased risk of COPD exacerbations.

Answer 48

elevated ratio of the diameter of the pulmonary artery to aorta on chest CT gastroesophageal reflux

Question 49

The single greatest risk factor for hospitalization with an exacerbation is a ___

Answer 49

history of previous hospitalization.

Question 50

The need for inpatient treatment of exacerbations is suggested by the presence of respiratory acidosis and hypercarbia, new or worsening hypoxemia, severe underlying disease, and those whose living situation is not conducive to careful observation and the delivery of prescribed treatment.

Question 51

Bacteria frequently implicated in COPD exacerbations include ____

Answer 51

Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Chlamydia pneumoniae

Question 52

In patients admitted to the hospital, the use of _____reduces the length of stay, hastens recovery, and reduces the chance of subsequent exacerbation or relapse.

Answer 52

systemic glucocorticoids

Question 53

_____, is the most frequently reported acute complication of glucocorticoid treatment.

Answer 53

Hyperglycemia

Question 54

Supplemental O2 should be supplied to maintain oxygen saturation ___

Answer 54

≥90%.

Question 55

Contraindications to NIPPV include ___

Answer 55

cardiovascular instability, impaired mental status, inability to cooperate, copious secretions or the inability to clear secretions, craniofacial abnormalities or trauma precluding effective fitting of mask, extreme obesity, or significant burns.

Question 56

Among stable COPD patients in the primary care setting with FEV1≥80% or mmRC<2* and are not in exacerbation, we suggest the use of ______

Answer 56

LAMA monotherapy over LABA monotherapy or LABA/LAMA combination therapy

Question 57

Among stable COPD patients in the primary care setting with FEV1<80% or mmRC≥2* with increased risk for exacerbations and absence of concurrent respiratory infection*

Answer 57

inhaled corticosteroids in combination with inhaled long-acting bronchodilators

Question 58

Among outpatients with COPD, we recommend initiation of oral antibiotics in the presence of at least two of the following symptoms: _____

Answer 58

increased dyspnea, increased frequency of cough increased sputum volume or purulence

Question 59

Among patients with advanced-stage or end-stage COPD and/or refractory dyspnea, we suggest to consider the use of ____ with close supervision to relieve dyspnea that persists despite maximized medical management

Answer 59

opioids

Question 60

Among symptomatic COPD patients with moderate to severe breathlessness,**** who are not hypoxemic, and does not fulfill criteria for long-term oxygen therapy (LTOT), we suggest using _____ for relief of dyspnea with caution and close supervision of attending physician

Answer 60

low flow oxygen therapy

Question 61

Among COPD patients in acute exacerbation with worsening symptoms and not responding to bronchodilators, we recommend the use of short course*** ______ in the primary care setting

Answer 61

oral steroids

Question 62

Among patients with COPD, we recommend the use of ____ in the management of acute exacerbation. In situations where it is not readily available, ____ may be used

Answer 62

SABA+SAMA (combination therapy)

Question 63

Among stable COPD patients in the primary care setting with FEV1<80% or mMRC≥2* and are not in exacerbation, we suggest the use of ____ over ____

Answer 63

LAMA over LABA

Question 64

A 62-year-old male with COPD has a history of 0 exacerbations in the past year and reports occasional dyspnea but no significant daily symptoms (mMRC 1, CAT 8). Which initial treatment is most appropriate? A) Long-acting muscarinic antagonist (LAMA) B) Long-acting beta agonist (LABA) C) Inhaled corticosteroid (ICS) D) Short-acting bronchodilator

Answer 64

D

Question 66

A patient with COPD presents with two exacerbations in the past year, one requiring hospitalization. The patient’s CAT score is 15. Which treatment option is most appropriate? A) LAMA B) LABA C) LAMA + LABA D) ICS + LABA

Answer 66

A

Question 67

A 68-year-old female with COPD reports a CAT score of 22 and two moderate exacerbations in the past year. Which therapy should be considered? A) LAMA B) LAMA + LABA C) ICS + LABA D) LABA only

Answer 67

B

Question 68

For a COPD patient in Group D with eosinophil counts ≥300 cells/μL, which treatment is specifically indicated? A) LAMA B) LAMA + LABA C) ICS + LABA D) Triple therapy (ICS + LABA + LAMA)

Answer 68

C