Deck 25: Obstructive Lung Disease: Chronic Obstructive Pulmonary Disease Copd, Asthma, and Related Diseases

Question 1

Which of the following signs and symptoms is most closely associated with respiratory failure in a COPD patient?

A) Bilateral wheezing
B) Changes in mental status
C) Dyspnea on exertion
D) Excessive sputum production

Answer 1

B
Explanation: Late signs of COPD may include use of accessory muscles of respiration (e.g., sternocleidomastoid), edema from cor pulmonale, mental status changes caused by hypoxia or hypercapnia (especially in acute exacerbations of chronic, severe disease), or asterixis (i.e., involuntary flapping of the hands when held in an extended position, as in "stopping traffic").

Question 2

Which complaint is most closely associated with the diagnosis of chronic bronchitis?

A) Airway enlargement
B) Chronic productive cough
C) Dyspnea on exertion
D) Hemoptysis

Answer 2

B
Explanation: Chronic bronchitis is defined in clinical terms as a condition in which chronic productive cough is present for at least 3 months per year for at least 2 consecutive years.

Question 3

What is the critical alpha₁-antitrypsin level below which lung elastin is attacked and broken down?

A) 57 mg/dl
B) 84 mg/dl
C) 100 mg/dl
D) 150 mg/dl

Answer 3

A
Explanation: In the face of a severe deficiency of alpha₁-antitrypsin (i.e., when serum levels fall below a "protective threshold" value of 11 µmol/L, or 57 mg/dl), neutrophil elastase may go unchecked, causing breakdown of elastin and resulting dissolution of alveolar walls.

Question 4

Approximately how many individuals died of COPD in the United States in 2008?

A) 145,000
B) 210,000
C) 550,000
D) 1,000,000

Question 5

What is the approximate cost of COPD to the U.S. health system?

A) $20 billion
B) $30 billion
C) $40 billion
D) $50 billion

Question 6

Which of the following signs associated with COPD is considered a late manifestation?

A) Accessory muscle usage
B) Frequent coughing
C) Shortness of breath
D) Wheezing

Question 7

During an acute exacerbation of COPD, what is the role of IV methylprednisolone?

A) It accelerates recovery as noted in FEV₁.
B) It causes pulmonary edema due to retention of water.
C) It causes severe immunosuppression and worsens outcomes.
D) It has been shown to have no effect.

Question 8

The mechanisms of airway obstruction in COPD include which of the following?
1) Airway remodeling
2) Inflammation and obstruction of small airway
3) Loss of elasticity
4) Active bronchospasm

A)1 and 2 only
B)1 and 4 only
C)2, 3, and 4 only
D)3 and 4 only

Question 9

A patient is experiencing an exacerbation of COPD. He is 65 years old, slim, and in notable distress with tachypnea, tachycardia, and an arterial blood pH of 7.29. Which of the following therapies would be most indicated?

A) Intrapulmonary percussive ventilation
B) Intubation and mechanical ventilation
C) Nasal CPAP
D) Noninvasive ventilation

Question 10

What percentage of all cases of COPD is caused by alpha₁-antitrypsin deficiency?

A) 2% to 3%
B) 10% to 15%
C) 25% to 40%
D) 50% to 75%

Question 11

Which of the following are typically found in a patient with COPD?
1) Airway inflammation
2) Partially reversible airway obstruction
3) Progressive airway obstruction
4) Restrictive disease

A)2 and 3 only
B)1 and 4 only
C)1, 2, and 3 only
D)2, 3, and 4 only

Question 12

Which airways are most susceptible to airway obstruction in patients with COPD?

A) Small
B) Medium
C) Large
D) Central

Question 13

It is not clear whether your patient has COPD or asthma. Which of the following characteristics is most closely associated with the diagnosis of asthma?

A) Daily phlegm production
B) Diminished vascularity on the chest radiograph
C) Low diffusion capacity
D) Reversal of the FEV₁ after use of a bronchodilator

Question 14

Which of the following medications is indicated for regular use in patients with stable COPD?

A) Antibiotics
B) Beta-2 agonists
C) Corticosteroids
D) Methylxanthines

Question 15

Approximately how many Americans are affected by COPD?

A) 8 million
B) 16 million
C) 24 million
D) 32 million

Question 16

What is the benefit of pulmonary rehabilitation in patients with moderate to severe COPD?

A) Improves exercise tolerance.
B) Improves FEV₁.
C) Improves lung function.
D) Improves survival.

Question 17

Emphysema is defined as:

A) chronic productive cough.
B) conducting airway enlargement.
C) destruction of alveolar walls without fibrosis.
D) hemoptysis associated with productive cough and alveolar-capillary membrane destruction.

Question 18

Which of the following medications is generally only used if the patient still has debilitating symptoms from stable COPD, despite inhaled bronchodilator therapy?

A) Antibiotics
B) Beta-2 agonists
C) Corticosteroids
D) Methylxanthines

Question 19

Where does COPD rank among the leading causes of death in the United States?

A) First
B) Second
C) Third
D) Fourth

Question 20

What is the leading risk factor for the development of COPD?

A) Air pollution
B) Alpha₁-antitrypsin deficiency
C) Cigarette smoking
D) Secondhand smoke

Question 21

A patient is admitted to the emergency department with an acute asthma exacerbation. Based on the following blood gas results, how severe was the asthma attack? pH 7.35, PaO₂ 58 mm Hg, PaCO₂ 46 mm Hg, HCO₃^- 18 mEq/L, SaO₂ 89%

A) Mild
B) Moderate
C) Severe
D) Normalized

Question 22

What stimulus is most commonly used in bronchoprovocation testing in the patient suspected to have asthma?

A) Acetylcysteine
B) Leukotriene inhibitors
C) Methacholine
D) Methylprednisolone

Question 23

An asthma patient's best effort produces a PEFR of 55% of personal best. What is indicated at this time?

A) Patient should lie down and try to relax.
B) Patient should probably seek medical attention now.
C) Patient should retry the PEFR maneuver.
D) Patient should take his or her controller medications.

Question 24

What treatment for patients with COPD has been shown to improve long-term survival?

A) Bronchodilators
B) Corticosteroids
C) Mechanical ventilation
D) Oxygen

Question 25

What classification of drug would the leukotriene inhibitors fall under?

A) Antiinflammatory
B) Corticosteroid
C) Long-acting bronchodilator
D) Short-acting bronchodilator

Question 26

What test is most useful for the diagnosis of asthma in the symptom-free patient?

A) Arterial blood gases
B) Bronchoprovocation testing with pulmonary function tests
C) Chest radiograph
D) Ventilation-perfusion ratio () scans

Question 27

Which of the following pulmonary function improvements have been associated with lung volume-reduction surgery (LVRS) in patients with emphysema?
1) Improved exercise endurance
2) Improved FEV₁
3) Improved quality-of-life
4) Improved survival

A)1, 3, and 4 only
B)2 and 4 only
C)3 only
D)2, 3, and 4 only

Question 28

What medication is currently the most effective for the treatment of asthma?

A) Corticosteroids
B) Fast-acting beta-2 agonists
C) Long-acting beta-2 agonists
D) Nonsteroidal antiinflammatory drugs

Question 29

Identify the drug whose regular use in the treatment of asthma may worsen control or even increase the risk of death by asthma.

A) Anticholinergic
B) Antiinflammatory
C) Beta-2 agonists
D) Corticosteroid

Question 30

What does the National Asthma Education Project recommend be measured at home in patients with moderate to severe asthma?

A) Pulse oximeter
B) Degree of pulmonary shunt
C) DLCO
D) Peak expiratory flow

Question 31

Which of the following statements are true about the incidence of asthma?
1) The prevalence has increased significantly over the past 20 years in the United States.
2) The mortality has remained the same over the past 20 years in the United States.
3) Researchers have determined the causes of asthma and are working on a vaccine.
4) Diagnosis of asthma is done in a physician's office following an extensive clinical assessment.

A)1 and 3 only
B)1 only
C)1 and 2 only
D)1, 2, and 4 only

Question 32

According to the National Asthma Education Project guidelines, what should be considered if the patient with asthma requires more than 3 or 4 puffs of beta-2 agonists per day?

A) Add or increase the dose of anticholinergic.
B) Add or increase the dose of antiinflammatory.
C) Add or increase the dose of magnesium sulfite.
D) Increase dose of beta-2 agonists.

Question 33

How much improvement is needed in the FEV₁ after bronchodilator therapy before reversibility can be considered present in the patient with obstructive lung disease?

A) 50 ml
B) 200 ml
C) 350 ml
D) 500 ml

Question 34

Which of the following symptoms is not a typical symptom of asthma?

A) Cough
B) Shortness of breath
C) Chest tightness
D) Chest pain

Question 35

What causes the degranulation of mast cells in asthma patients?

A) Antigens attaching to IgE molecules on the mast cell surface.
B) Antigens attaching to proteins receptors on mast cell surface.
C) Irritant receptors on the mast cells are stimulated by antigens.
D) Infectious particles attacking the mast cells.

Question 36

What lung disease is the most common current indication for lung transplantation?

A) Adult respiratory distress syndrome
B) COPD
C) Pneumoconiosis
D) Pulmonary fibrosis

Question 37

Which of the following side effects is associated with the use of inhaled corticosteroids?

A) Bronchospasm
B) Frequent cough
C) Nausea
D) Oral candidiasis

Question 38

Which of the following tests is recommended as part of the initial assessment of asthma?

A) Arterial blood gas
B) Chest radiograph
C) Spirometry
D) scan

Question 39

What pathophysiologic characteristic of asthma has been most recently emphasized in the description and subsequent treatment of this disease?

A) Hyperactivity of the airways
B) Hyperinflation of the lung parenchyma
C) Inflammation of the airways
D) Mucus plugging of the airways

Question 40

Which of the following problems is associated with intravenous augmentation of synthetic alpha₁-antitrypsin for the patient with genetic emphysema?

A) Bronchospasm
B) Expense
C) Headache
D) Nausea

Question 41

Bronchiectasis characterized by progressive, distal enlargement of the airways, resulting in sac-like dilatations is classified as:

A) cylindrical bronchiectasis.
B) varicose bronchiectasis.
C) cystic bronchiectasis.
D) obstructive bronchiectasis.

Question 42

What step must be taken to gain control of asthma in a patient that is experiencing frequent emergency department visits?

A) Regular antibiotic therapy
B) Regular anticholinergic therapy
C) Environmental control
D) Regular immunotherapy

Question 43

What etiologic factor is associated with the onset of nocturnal asthma?

A) Aspiration of gastric acid at night
B) Supine position
C) Variation in acetylcholine secretion at night
D) Variation in the secretion of insulin at night

Question 44

Your patient has bronchiectasis. Which of the following therapies is most needed?

A) Antibiotics
B) Bronchodilators
C) Incentive spirometry
D) Oxygen

Question 45

Which of the following asthma medications is not typically administered during pregnancy?

A) Albuterol
B) Cromalyn
C) Ipratropium bromide
D) Theophylline

Question 46

Which bronchodilator is commonly used in the hospital management of acute asthma exacerbation but is not considered the first-line bronchodilator?

A) Albuterol
B) Ipratropium bromide
C) Salmeterol
D) Arformoterol

Question 47

Which medication is a once-daily combination of a beta-2 agonist and an inhaled corticosteroid?

A) Combivent Respimat
B) Advair
C) Flovent
D) Breo Ellipta

Question 48

You are called to the ER to assess a 25-year-old female patient in status asthmaticus. Her PEFR results of pre- and post-bronchodilator therapy are given below: You should suggest to the ER physician to:

A) stop the bronchodilators.
B) repeat the PEF measurement.
C) increase the medication dosage.
D) continue current therapy.

Question 49

Which of the following has been identified as the most common cause of occupational asthma?

A) Alpha₁-antitrypsin deficiency
B) IgE abnormality
C) Nitric oxide deficiency
D) Toluene diisocyanate

Question 50

Of the following common causes of asthma, which is the least likely to cause exercise-induced asthma?

A) Long distance cycling
B) Running cross country
C) Skiing and snowboarding
D) Swimming indoors

Question 51

What treatment strategy is most controversial for a patient with asthma?

A) Antibiotic therapy
B) Anticholinergic therapy
C) Environmental control
D) Immunotherapy

Question 52

What medical problems are suggested by Mr. Jones' medical history?

A) Chronic bronchitis
B) Emphysema
C) Occupational asthma
D) Obstructive bronchiectasis

Question 53

Which medication is an anticholinergic bronchodilator?

A) Ipratropium bromide
B) Vilanterol
C) Salmeterol
D) Terbutaline

Question 54

What beta-2 agonist is associated with 12 to 24 hr of bronchodilation?

A) Albuterol
B) Metaproterenol
C) Salmeterol
D) Aclinidium

Question 55

Identify the hallmark symptom of bronchiectasis.

A) Evidence of cystic spaces and tram tracks on the chest radiograph
B) Hemoptysis
C) Large amounts of purulent sputum
D) Variable dyspnea

Question 56

Which of the following procedures would you recommend to further assess Mr. Jones' condition?
1) Pre-post PFT
2) Exercise testing
3) Chest x-ray
4) Room air ABG

A)1 and 4 only
B)1, 2, and 3 only
C)2, 3 and 4 only
D)1, 3, and 4 only

Question 57

Which of the following strategies is useful in the mechanical ventilation of a patient in status asthmaticus?
1) Allow peak inspiratory pressures to go as high as required.
2) Permissive hypercapnia.
3) Prolonged inspiratory time.
4) Small tidal volumes.

A)1, 2, and 3 only
B)2 and 4 only
C)3 only
D)2, 3, and 4 only

Question 58

Which factor is associated with a decrease in the plasma levels of theophylline in an asthmatic patient?

A) Cigarette smoking
B) Heart failure
C) Hepatic disease
D) Viral infections

Question 59

What medication would likely be the least often ordered during the emergency department management of an acute asthma attack?

A) Beta-2 agonists
B) Corticosteroids
C) Methylxanthines
D) Oxygen