Question 1

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

Accepted Answer

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?

Accepted Answer

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?

Accepted Answer

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?

Accepted Answer

COPD is now the third leading cause of death in the United States, accounting for an estimated 145,075 (or approximately 4% of all) deaths in 2008.

Question 5

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

Accepted Answer

In 2010, COPD caused 715,000 hospitalizations (which accounted for 1.9% of all hospitalizations in the United States), and, in 2010, COPD resulted in a total health expenditure of $49.9 billion. In this regard, COPD is a problem that is a frequent challenge for the respiratory clinician.

Question 6

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

Accepted Answer

Late signs of COPD may include use of accessory muscles of respiration (e.g., sternocleidomastoid).

Question 7

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

Accepted Answer

An early randomized controlled trial of IV methylprednisolone for patients with acute exacerbations has shown accelerated improvement in FEV₁ within 72 hr.

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

Accepted Answer

The answer of The mechanisms of airway obstruction in COPD...

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?

Accepted Answer

Criteria defining candidacy for noninvasive ventilation include acute respiratory acidosis (without frank respiratory arrest), hemodynamic stability, ability to tolerate the interface needed for noninvasive ventilation, ability to protect the airway, and lack of craniofacial trauma or burns, copious secretions, or massive obesity.

Question 10

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

Accepted Answer

Accounting for 2% to 3% of all cases of COPD, alpha₁-antitrypsin deficiency is severely underrecognized by health care providers, but it affects an estimated 100,000 Americans.

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

Accepted Answer

COPD (Chronic Obstructive Pulmonary Disease) is characterized by airway inflammation, partially reversible airway obstruction, and progressive airway obstruction. Restrictive disease is not a typical feature of COPD, but rather of other lung conditions.

Question 12

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

Accepted Answer

The mechanisms of airflow obstruction in COPD include inflammation and obstruction of small airways (<2 mm in diameter).

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?

Accepted Answer

The diagnosis of asthma is favored if the diminished FEV₁ obtained on spirometry can be normalized after use of an inhaled bronchodilator (reversible airway obstruction).

Question 14

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

Accepted Answer

Although the airflow obstruction from emphysema itself is irreversible, most (up to two-thirds) patients with stable COPD will demonstrate a reversible component of airflow obstruction, defined as a 12% and 200-ml rise in the post-bronchodilator FEV₁ and/or FVC. For this reason, as indicated in an algorithm developed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), bronchodilator therapy is recommended for patients with COPD.

Question 15

Approximately how many Americans are affected by COPD?

Accepted Answer

COPD is common, with recent estimates suggesting that 24 million Americans are affected. It is the third leading cause of death in the United States, responsible for 145,075 deaths in 2008.

Question 16

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

Accepted Answer

Comprehensive pulmonary rehabilitation is an additional important strategy for improving functional status. Indeed, randomized controlled trials show that a pulmonary rehabilitation program including education and a progressive exercise program can enhance exercise capacity, even though lung function and survival are not improved.

Question 17

Emphysema is defined as:

Accepted Answer

Emphysema is defined in anatomical terms as a condition characterized by abnormal, permanent enlargement of the airspaces beyond the terminal bronchiole, accompanied by destruction of the walls of the airspaces without fibrosis.

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?

Accepted Answer

Treatment with methylxanthines offers little additional bronchodilation in patients on inhaled bronchodilators, and generally it is reserved for patients with debilitating symptoms from stable COPD, despite optimal inhaled bronchodilator therapy.

Question 19

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

Accepted Answer

COPD is now the third leading cause of death in the United States.

Question 20

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

Accepted Answer

Cigarette smoking is the leading risk factor for developing COPD. It accounts for approximately 80% of all cases.

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