Chronic Obstructive Pulmonary Disease (COPD) and Asthma
1. Which pulmonary function test finding is characteristic of obstructive lung disease?
A. Decreased FEV₁/FVC ratio
B. Increased total lung capacity (TLC)
C. Decreased residual volume (RV)
D. Increased diffusing capacity (DLCO)
Answer: A
Explanation: A low FEV₁/FVC ratio (<70%) confirms obstructive lung diseases like COPD and asthma.
2. Which of the following statements about asthma is TRUE?
A. Asthma is primarily a restrictive lung disease.
B. Asthma symptoms are usually irreversible.
C. Asthma is characterized by airway hyperresponsiveness.
D. Asthma is primarily caused by smoking.
Answer: C
Explanation: Asthma is defined by airway hyperresponsiveness and reversible airway obstruction.
3. Which is the most effective intervention for reducing COPD mortality?
A. Long-acting beta-agonists (LABA)
B. Smoking cessation
C. Inhaled corticosteroids
D. Pulmonary rehabilitation
Answer: B
Explanation: Smoking cessation is the only intervention proven to slow COPD progression and reduce mortality.
4. Which of the following medications is NOT recommended as a first-line treatment for stable COPD?
A. Long-acting muscarinic antagonists (LAMA)
B. Long-acting beta-agonists (LABA)
C. Inhaled corticosteroids (ICS)
D. Systemic corticosteroids
Answer: D
Explanation: Systemic corticosteroids are reserved for acute exacerbations, not for long-term COPD management.
5. Which of the following is a feature of severe COPD?
A. Chronic productive cough
B. Barrel chest
C. Increased FEV₁
D. Hyperoxia
Answer: B
Explanation: Barrel chest results from lung hyperinflation in advanced COPD.
6. Which of the following is the most common risk factor for COPD?
A. Smoking
B. Air pollution
C. Occupational exposure
D. Genetic predisposition
Answer: A
Explanation: Cigarette smoking is the leading cause of COPD due to chronic inflammation and lung damage.
7. Which of the following findings is characteristic of emphysema?
A. Increased mucus production
B. Destruction of alveolar walls
C. Reversible bronchoconstriction
D. Interstitial fibrosis
Answer: B
Explanation: Emphysema is defined by alveolar wall destruction, leading to air trapping and hyperinflation.
8. What is the primary goal of oxygen therapy in COPD patients?
A. Normalize oxygen saturation to 100%
B. Reduce carbon dioxide levels
C. Maintain PaO₂ at 55-60 mmHg
D. Increase respiratory rate
Answer: C
Explanation: Target PaO₂ of 55-60 mmHg prevents hypoxia while avoiding CO₂ retention and respiratory acidosis.
9. Which medication is the first-line treatment for stable COPD?
A. Inhaled corticosteroids
B. Long-acting beta-agonists (LABA)
C. Short-acting beta-agonists (SABA)
D. Anticholinergics
Answer: D
Explanation: Anticholinergics (LAMA, e.g., tiotropium) are preferred as they reduce bronchoconstriction and mucus production.
10. Which test is required to diagnose COPD?
A. Arterial blood gas (ABG)
B. Chest X-ray
C. Spirometry
D. Peak expiratory flow rate
Answer: C
Explanation: Spirometry confirms COPD with an FEV₁/FVC ratio < 70% after bronchodilator use.
11. Which of the following is NOT a typical asthma trigger?
A. Dust mites
B. Cold air
C. Smoking
D. Pulmonary embolism
Answer: D
Explanation: Pulmonary embolism is not an asthma trigger; asthma is triggered by allergens, cold air, and irritants.
12. Which medication is the mainstay of long-term asthma control?
A. Short-acting beta-agonists (SABA)
B. Inhaled corticosteroids
C. Leukotriene receptor antagonists
D. Oral corticosteroids
Answer: B
Explanation: Inhaled corticosteroids (ICS) reduce airway inflammation, preventing asthma exacerbations.
13. Which of the following is a sign of severe asthma exacerbation?
A. Wheezing
B. Silent chest
C. Mild dyspnea
D. Productive cough
Answer: B
Explanation: Silent chest indicates severe airway obstruction, requiring emergency intervention.
14. Which value is used to assess asthma severity?
A. FEV₁
B. Total lung capacity (TLC)
C. Diffusing capacity (DLCO)
D. Inspiratory reserve volume
Answer: A
Explanation: FEV₁ is used to classify asthma severity and guide treatment decisions.
15. Which step is recommended for a patient with asthma who requires rescue inhalers multiple times per week?
A. Increase SABA dose
B. Add inhaled corticosteroids
C. Start oral corticosteroids
D. No changes needed
Answer: B
Explanation: Frequent SABA use indicates poor control; adding inhaled corticosteroids reduces inflammation.
Long-Term Oxygen Therapy (LTOT) and Home Ventilation
16. Which of the following patients would benefit most from long-term oxygen therapy (LTOT)?
A. COPD patient with PaO₂ of 65 mmHg
B. COPD patient with mild dyspnea on exertion
C. COPD patient with PaO₂ < 55 mmHg
D. COPD patient with FEV₁ < 80% but normal PaO₂
Answer: C
Explanation: LTOT is recommended when PaO₂ < 55 mmHg or SpO₂ < 88% to prevent complications.
17. Which is the most appropriate oxygen delivery system for home use in a COPD patient with chronic hypoxemia?
A. Venturi mask
B. Non-rebreather mask
C. Nasal cannula
D. Bag-valve-mask ventilation
Answer: C
Explanation: A nasal cannula is the most comfortable and practical option for long-term home oxygen therapy.
18. What is the primary goal of BiPAP therapy in chronic respiratory failure?
A. Increase oxygen saturation to 100%
B. Increase total lung capacity
C. Reduce oxygen dependency
D. Improve alveolar ventilation and CO₂ elimination
Answer: D
Explanation: BiPAP improves ventilation by assisting with CO₂ removal in hypercapnic respiratory failure.
19. Which is an indication for long-term oxygen therapy in COPD patients?
A. PaO₂ < 80 mmHg
B. PaO₂ < 55 mmHg
C. FEV₁ < 50%
D. Peak flow < 250 L/min
Answer: B
Explanation: LTOT is indicated when PaO₂ is < 55 mmHg to prevent hypoxemia-related complications.
20. What is the target SpO₂ for COPD patients on long-term oxygen therapy?
A. 85-90%
B. 92-96%
C. 88-92%
D. >98%
Answer: C
Explanation: 88-92% SpO₂ prevents hypoxia while avoiding hypercapnia and CO₂ retention.
21. Which mode of ventilation is preferred for home management of COPD with chronic hypercapnia?
A. Invasive mechanical ventilation
B. High-flow nasal cannula
C. Non-invasive positive pressure ventilation (NIPPV)
D. Continuous mandatory ventilation
Answer: C
Explanation: NIPPV (e.g., BiPAP) supports ventilation without intubation, improving CO₂ elimination.
22. Which condition is an indication for home mechanical ventilation?
A. Mild COPD
B. Severe obstructive sleep apnea
C. Pneumonia
D. Acute asthma exacerbation
Answer: B
Explanation: Severe obstructive sleep apnea (OSA) may require home ventilation with CPAP or BiPAP.
Pulmonary Rehabilitation and Patient Management
23. Which component is NOT included in pulmonary rehabilitation programs?
A. Exercise training
B. Smoking cessation counseling
C. Long-term corticosteroid therapy
D. Nutritional support
Answer: C
Explanation: Pulmonary rehabilitation focuses on exercise, nutrition, and education, not long-term corticosteroids.
24. Which breathing technique is most effective for COPD patients to reduce dyspnea?
A. Diaphragmatic breathing
B. Shallow breathing
C. Breath-holding
D. Rapid breathing
Answer: A
Explanation: Diaphragmatic breathing strengthens the diaphragm and improves air exchange.
25. Which vaccination is recommended for all COPD patients?
A. Tuberculosis vaccine
B. Influenza and pneumococcal vaccines
C. Hepatitis B vaccine
D. Rotavirus vaccine
Answer: B
Explanation: COPD patients should receive annual influenza vaccines and pneumococcal vaccines to prevent infections.
Additional Questions
26. What is the primary cause of airway obstruction in COPD?
A. Alveolar hyperinflation
B. Bronchial hyperreactivity
C. Mucus plugging and airway remodeling
D. Pulmonary fibrosis
Answer: C
Explanation: Chronic inflammation leads to mucus hypersecretion and airway remodeling in COPD.
27. Which of the following conditions is a restrictive lung disease?
A. COPD
B. Asthma
C. Pulmonary fibrosis
D. Bronchiectasis
Answer: C
Explanation: Pulmonary fibrosis leads to lung stiffness and reduced compliance, causing a restrictive pattern on spirometry.
28. Which factor predicts mortality in COPD patients?
A. Age
B. BMI
C. FEV₁
D. Smoking history
Answer: C
Explanation: FEV₁ is the best predictor of disease progression and mortality in COPD.
29. Which structure is affected in emphysema?
A. Alveoli
B. Bronchi
C. Pleura
D. Pulmonary artery
Answer: A
Explanation: Emphysema involves destruction of alveolar walls, reducing gas exchange surface area.
30. Which of the following is a side effect of long-term corticosteroid use in asthma?
A. Osteoporosis
B. Hypoglycemia
C. Weight loss
D. Hypotension
Answer: A
Explanation: Long-term corticosteroid use increases the risk of osteoporosis, hyperglycemia, and Cushing’s syndrome.