Deck 4: Chronic Obstructive Pulmonary Disease

Question 1

What clinical finding in the COPD patient suggests that long-term oxygen therapy is likely to benefit the patient?

A)Loud P-2
B)Diminished heart sounds
C)Diminished PMI
D)Diminished breath sounds

Answer 1

A

Question 2

Your patient with COPD has right axis deviation on his ECG tracing.What does this indicate?

A)Right atrial hypertrophy
B)Right ventricular hypertrophy
C)Left atrial hypertrophy
D)Left ventricular hypertrophy

Answer 2

B

Question 3

What is the preferred route of administration for corticosteroids in patients with COPD?

A)Oral tablets
B)Intravenous
C)MDI
D)Subcutaneous injections

Answer 3

C

Question 4

Which of the following symptoms is least common among COPD patients?

A)Cough
B)Exertional dyspnea
C)Sputum production
D)Chest pain

Question 5

Which of the following physical examination findings is least associated with an acute exacerbation of COPD?

A)Abnormal sensorium
B)Heart rate = 124/min
C)Respiratory rate = 14/min
D)None of the above

Question 6

Which of the following statements is true regarding the incidence of COPD in the United States?

A)It is probably significantly underestimated
B)It is easy to estimate based on hospital admission data
C)Studies based on pulmonary function data indicate less COPD than originally thought
D)Studies of incidence using phone interviews have helped

Question 7

Which of the following findings on the chest film is associated with hypertrophy of the airways due to heavy cigarette consumption?

A)Tram tracks
B)An enlarged right ventricle
C)Kerly B lines
D)Air bronchograms

Question 8

About how many deaths are attributed to COPD each year in the United States?

A)10,000
B)50,000
C)100,000
D)200,000

Question 9

Which of the following findings during pulmonary function testing is suggestive of severe disease in a COPD patient?

A)Peak flow of 120 L/min
B)FEV1 0.8 L
C)DLCO 22 ml/min/mmHg
D)FVC = 2.6 L

Question 10

Which category of COPD patient would benefit the most from smoking cessation?

A)The one with mild disease
B)The one with moderate disease
C)The one with severe disease
D)The one with severe disease but under the age of 60 years

Question 11

Your patient has advanced emphysema.Which of the following findings on the chest film is least associated with this pathology?

A)Large retrosternal airspace
B)Low,flat diaphragm
C)Small narrow heart
D)Elevated hilum on the right

Question 12

What is the most common source of noxious fumes and inhaled particles associated with the cause of COPD?

A)Smog
B)Smoking
C)Occupational dusts
D)Indoor pollutants

Question 13

COPD patients with cor pulmonale typically have which of the following physical examination findings?

A)JVD
B)Hepatomegaly
C)Pedal edema
D)All the above

Question 14

What is the goal of bronchodilator therapy in the COPD patient with moderate to severe disease?

A)Improve the quality of life
B)Stop the progression of the disease
C)Reduce the risk of sudden death
D)Keep the airways clear of mucus

Question 15

The typical ABG findings in patients with advanced COPD would include

A)Moderate hypoxemia and respiratory alkalosis
B)Moderate hypoxemia and respiratory acidosis
C)Mild hypoxemia and normal CO₂
D)Severe hypoxemia and respiratory alkalosis

Question 16

What classification of COPD patient can benefit from pulmonary rehabilitation?

A)Mild disease
B)Moderate disease
C)Severe disease
D)All the above

Question 17

Your patient has an acute exacerbation of COPD.What medication should not be started at this time?

A)Albuterol
B)Atrovent
C)Corticosteroids
D)Methylxanthines

Question 18

What clinical laboratory data finding is suggestive of chronic hypoxemia in the COPD patient?

A)Hyperkalemia
B)Hyponatremia
C)Polycythemia
D)Elevation of total CO₂

Question 19

What term is used to describe a unique breathing pattern in COPD patients in which the lower lateral margins of the chest wall pull inward with each inspiration?

A)Hoover's sign
B)Homans' sign
C)Respiratory alternans
D)Respiratory retractions

Question 20

About what percent of smokers are formally diagnosed with COPD?

A)3 to 5%
B)15 to 20%
C)25 to 35%
D)50%

Question 21

Common causes of acute exacerbation in a COPD patient include all the following except:

A)Infection
B)Pulmonary edema
C)Pulmonary embolism
D)Pulmonary fibrosis

Question 22

Which of the following findings on the chest film suggests a more severe case of emphysema?

A)An enlarged right ventricle
B)Vertical positioning of the heart
C)Excessive vascular tapering
D)Horizontal positioning of the clavicles

Question 23

A patient has been smoking 2.5 packs of cigarettes per day for the past 25 years.What is his smoking history in pack years?

A)52 pack years
B)62.5 pack years
C)75 pack years
D)None of the above

Question 24

Which of the following approaches to mechanical ventilation in the COPD patient is most likely to help avoid auto-PEEP?

A)Small tidal volumes
B)Reduced inspiratory flows
C)Minimal expiratory times
D)Use of IMV

Question 25

Your COPD patient is suspected of having cor pulmonale.Which of the following clinical findings supports this diagnosis?

A)An enlarged spleen
B)Cyanosis of the mucous membranes
C)A gallop heart rhythm
D)JVD

Question 26

You are caring for a COPD patient who is experiencing an acute exacerbation due to bilateral pneumonia which is not expected to resolve quickly.It has been determined that the patient needs ventilatory assistance.Which of the following approaches to positive pressure ventilation is NOT likely to be the best option?

A)Intubation with IMV
B)Intubation with pressure support
C)Noninvasive positive pressure ventilation
D)Intubation with CPAP

Question 27

What pulmonary problem is associated with the PMI located in the epigastric area?

A)Chronic bronchitis
B)Emphysema
C)Asthma
D)Cystic fibrosis

Question 28

What abnormality on the ECG suggests right axis deviation due to cor pulmonale?

A)Positive QRS in lead II
B)Negative QRS in lead I
C)Tall QRS waves in the limb leads
D)Small QRS waves in the chest leads

Question 29

What treatment is probably the most important during the initial care of the COPD patient experiencing an acute exacerbation due to pneumonia?

A)Antibiotics
B)Oxygen therapy
C)Bronchodilators
D)Corticosteroids

Question 30

What characteristics of COPD patients indicate that lung volume reduction surgery may be useful in improving the quality of life?

A)Upper lobe disease and poor exercise tolerance
B)Lower lobe disease and evidence of cor pulmonale
C)Upper lobe disease and FEV1 <60% of predicted
D)Homogenous disease and maximal treatment has shown no benefit