Deck 6: Chronic Obstructive Pulmonary Diseases

Question 1

Generally,COPD is BEST diagnosed using which of the following tests?

A)Chest x-ray
B)Pulmonary function tests
C)Arterial blood gases
D)Exercise test

Answer 1

B
CXR findings are evident only in severe CODP cases.It is of limited value in diagnosing obstructive lung disease.Results of spirometry testing (PFTs)are more important in identifying the presence of most obstructive lung diseases.

Question 2

Which of the following pathological changes results in lung recoil reduction in a patient with chronic inflammation secondary to inhalation of cigarette smoke?

A)Narrowing of small airways
B)Increased numbers of inflammatory cells
C)Reduction in airway remodeling
D)Loss of alveolar attachments (tethers)

Answer 2

D
Chronic inflammation results in destruction of lung parenchyma,the respiratory bronchioles,and alveoli,leading to loss of alveolar attachments (tethers that hold the airways open),which decrease lung recoil.

Question 3

Cystic fibrosis (CF)is characterized by which of the following statements?

A)Most common life-threatening genetic trait in Asian Americans
B)Genetic transmission follows the pattern for autosomal dominant traits
C)Mucus accumulates in conducting airways due to increased production and difficulty clearing secretions
D)Obstruction of the ducts in the liver by inspissated secretions occurs early

Answer 3

C
CF consists of disease in the conducting airways caused by increased production of secretions or failure to clear secretions.This leads to mucus accumulation in bronchial regions and in bronchioles.Mucus stasis occurs in nasal sinuses,sweat glands,small intestine,pancreas,and biliary system.It is common in Caucasians and is an autosomal recessive trait.

Question 4

Which of the pulmonary function test findings BEST indicates COPD?

A)High FEV₁,high FEV₁/FVC,low residual volume
B)High FEV₁,no change in FEV₁/FVC,low residual volume
C)Low FEV₁,low FEV₁/FVC,high residual volume
D)Low FEV₁,no change in FEV₁/FVC,no change in residual volume

Question 5

An irreversible dilation of one or more bronchi with chronic inflammation and infection is characterized by which of the following lung diseases?

A)Emphysema
B)Chronic bronchitis
C)Bronchiectasis
D)Asthma

Question 6

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD)classification of COPD severity,which of the following stages is associated with a FEV₁ (% predicted)of 30 to 50?

A)Stage I (mild)
B)Stage II (moderated)
C)Stage III (severe)
D)Stage IV (very severe)

Question 7

In older children with CF,an enzyme deficiency results in fat and protein maldigestion,producing a distended abdomen and bulky,greasy,foul-smelling stools.This deficiency is associated with which of the following organs?

A)Pancreas
B)Gallbladder
C)Liver
D)Intestine

Question 8

Which of the clinical manifestations distinguishes chronic bronchitis?

A)Presence of a chronic cough for 6 months in 1 year
B)Presence of a chronic cough for 3 months in 2 successive years
C)Evidence of hypersecretion of mucus in the large airways
D)Gland-to-bronchial wall thickness ratio (Reid index)is 3

Question 9

Clinical features of CF include which of the following?

A)Persistent cough and recurrent lung infiltrates
B)Meconium ileus
C)Failure to thrive with steatorrhea (excessive fat in feces)
D)All of the above

Question 10

Which of the following types of emphysema are described as proximal dilation of the respiratory bronchioles,with alveolar ducts and sacs remaining normal?

A)Centrilobular
B)Panlobular
C)Distal acinar
D)None of the above

Question 11

Increased work of breathing and fatigue in a patient with asthma is BEST explained by which of the following physiological changes?

A)Narrowing of peripheral airways at all levels of the tracheobronchial tree
B)Increase in residual volume
C)Suboptimal length-tension curve of diaphragm/intercostals muscles
D)Ventilation/perfusion mismatching

Question 12

The finding of hyper-resonant sounds due to lung hyperinflation is associated with which of the following physical examination tests?

A)Auscultation
B)Percussion
C)Palpation
D)Observation

Question 13

Destruction of alveolar walls and enlargement of the airspaces distal to terminal bronchioles describe which of the following lung conditions?

A)Chronic bronchitis
B)Emphysema
C)Asthma
D)Bronchiectasis

Question 14

Which of the following conditions is typically associated with bronchiectasis due to traction?

A)Pertussis
B)Chronic gastroesophageal reflux
C)Cystic fibrosis
D)Sarcoidosis

Question 15

Which of the following physical examination test results is considered a hallmark of asthma?

A)Reduction in forced expiratory volume in the first second (FEV₁).
B)FEV₁/FVC ratio is low.
C)Maximum mid-expiratory flows (25% to 75% of FVC)is reduced.
D)Improvement in FEV₁ >12% after bronchodilator administration.

Question 16

Chronic obstructive pulmonary diseases (COPD)are diseases of the airways that produce obstruction to expiratory airflow.Which of the following problems relates to COPD?

A)Inflammation of mucosal lining of airways
B)Retained secretions
C)Bronchial constriction related to spasm of the smooth muscle
D)All of the above

Question 17

Which of the following signs are associated with lung hyperinflation noted in obstructive lung diseases?

A)Elevation of shoulder girdle
B)Horizontal ribs
C)Low,flattened diaphragm
D)All of the above

Question 18

In children,a diagnosis of classic CF is partially determined by which of the following sweat test values (sweat chloride concentrations)?

A)20 mEq/L
B)45 mEq/L
C)70 mEq/L
D)95 mEq/L

Question 19

Bronchiectasis characterized by bronchi that are distorted and bulging is more specifically termed which of the following types of bronchiectasis?

A)Varicoid bronchiectasis
B)Cylindrical bronchiectasis
C)Saccular bronchiectasis
D)Atypical bronchiectasis

Question 20

Which of the following medications are considered long-term controllers of asthma by producing an anti-inflammatory action?

A)Inhaled corticosteroids (Flovent)
B)Beta-adrenergic agonists (albuterol)
C)Anticholinergics (atrovent)
D)Antihistamine (Claritin)

Question 21

What is the minimum age a child can perform pulmonary function tests (PFTs)reliably?

A)3
B)6
C)8
D)10

Question 22

The key pathophysiological component of airway inflammation resulting from viral or allergen exposures BEST describes which of the following chronic obstructive pulmonary diseases?

A)Emphysema
B)Chronic bronchitis
C)Asthma
D)Bronchiectasis

Question 23

An "increased effort to breathe" or "air hunger" BEST describes which of the following terms?

A)Tachypnea
B)Hypoxic
C)Dyspnea
D)Platypnea

Question 24

Which of the following pathological events BEST describes how cystic fibrosis may manifest into bronchiectasis?

A)Chronic inflammation of airway wall with abnormal accumulation of lymphocytes
B)The outcome of mucus accumulation leading to repeated obstructive-infection cycles
C)Perforated airways that become obliterated resulting in large abnormal airspaces
D)Hypertrophy of submucosal glands and gland-to-bronchial wall thickness ratio

Question 25

Which of the following tests is considered the "gold standard" for diagnosing COPD and monitoring its progression?

A)Arterial blood gases (ABGs)
B)Pulmonary function tests (PFTs)
C)Chest radiograph
D)CT scans

Question 26

A patient with COPD with a score of 8 on the BODE index is associated with which of the following?

A)High mortality rate
B)Less severe COPD disease
C)Stage II COPD
D)FEV₁ = 50

Question 27

For a patient with COPD in pulmonary rehabilitation,exercise has been shown not to have an effect on exercise tolerance and tends to increase symptoms of dyspnea and fatigue.

Question 28

Which of the following conditions is associated with local bronchiectasis?

A)Chronic aspiration
B)Radiation fibrosis
C)Inhaled peanut
D)Cystic fibrosis

Question 29

A 31-year-old male who was diagnosed with asthma at age 7 years developed symptoms of intermittent wheezing and shortness of breath precipitated by a recent exercise bout.Which of the following recommendations would BEST improve this patient's tolerance to exercise?

A)Avoid animals and smoke
B)Use prescribed medication prior to exercise
C)Encourage daily use of a peak-flow meter
D)Perform postural exercises and pectoral stretching

Question 30

What abnormal physiological change develops in response to the presence of arterial hypoxemia in a patient with COPD?

A)Polycythemia
B)Tachypnea
C)Thrombocythemia
D)Anemia