COPD

Question 1

What spirometry value confirms airflow obstruction in COPD?

Answer 1

FEV₁/FVC < 0.7.

Question 2

What is the FEV₁ range for GOLD Stage I (Mild) COPD?

Answer 2

FEV₁ ≥ 80% of the predicted value

Question 3

What is the FEV₁ range for GOLD Stage II (Moderate) COPD?

Answer 3

FEV₁ is ≥ 50% but < 80% of the predicted value

Question 4

What is the FEV₁ range for GOLD Stage III (Severe) COPD?

Answer 4

FEV₁ is ≥ 30% but < 50% of the predicted value.

Question 5

What FEV₁ value defines GOLD Stage IV (Very Severe) COPD?

Answer 5

FEV₁ < 30% of the predicted value.

Question 6

What is FEV₁?
a) The total volume of air exhaled during a spirometric maneuver
b) The volume of air exhaled in the first second of a forced expiratory maneuver
c) The maximum inspiratory capacity of the lungs
d) The residual air left in the lungs after expiration

Answer 6

The volume of air exhaled in the first second of a forced expiratory maneuver

Question 7

What is FVC?
a) The volume of air exhaled in the first second of a spirometric maneuver
b) The forced expiratory flow at 25% to 75% of exhalation
c) The total volume of air exhaled during the entire spirometric maneuver
d) The maximum airflow rate during forced expiration

Answer 7

The total volume of air exhaled during the entire spirometric maneuver

Question 8

What characterizes airflow obstruction in COPD?
a) An increased ratio of FEV₁/FVC
b) A chronically reduced ratio of FEV₁/FVC
c) A normal FEV₁ and FVC
d) Increased FVC with decreased FEV₁

Answer 8

A chronically reduced ratio of FEV₁/FVC

Question 9

What is the most common type of emphysema associated with cigarette smoking?
a) Panlobular emphysema
b) Centrilobular emphysema
c) Paraseptal emphysema
d) Bullous emphysema

Answer 9

Centrilobular emphysema

Question 10

Which type of emphysema is associated with α1-antitrypsin (α1AT) deficiency?
a) Centrilobular emphysema
b) Panlobular emphysema
c) Paraseptal emphysema
d) Mixed emphysema

Answer 10

Panlobular emphysema

Question 11

Paraseptal emphysema is typically distributed along which area of the lung?
a) Upper lobes and central regions
b) Pleural margins with sparing of central lung regions
c) Lower lobes and peripheral regions
d) Across the entire acinar unit

Answer 11

Pleural margins with sparing of central lung regions

Question 12

Which type of emphysema is most prominent in the upper lobes and superior segments of the lower lobes?
a) Panlobular emphysema
b) Centrilobular emphysema
c) Paraseptal emphysema
d) Irregular emphysema

Answer 12

Centrilobular emphysema

Question 13

Which of the following interventions has been shown to improve survival in patients with COPD?
a) Smoking cessation
b) Oxygen therapy in chronically hypoxemic patients
c) Lung volume reduction surgery (LVRS) in selected emphysema patients
d) All of the above

Answer 13

All of the above

Question 14

A 65-year-old patient with severe COPD is chronically hypoxemic. Which intervention is most likely to improve their survival?
a) Triple inhaled therapy
b) Oxygen therapy
c) Lung volume reduction surgery
d) Smoking cessation

Answer 14

Oxygen therapy

Question 15

Which intervention is specifically targeted for selected emphysema patients with poor quality of life and localized upper-lobe disease?
a) Triple inhaled therapy
b) Smoking cessation
c) Lung volume reduction surgery (LVRS)
d) Inhaled corticosteroids alone

Answer 15

Lung volume reduction surgery (LVRS)

Question 16

Which long-acting muscarinic antagonist (LAMA) showed a trend toward reduced mortality in a large randomized clinical trial?
a) Umeclidinium
b) Tiotropium
c) Glycopyrronium
d) Revefenacin

Answer 16

Tiotropium

Question 17

What is the most frequent side effect of long-acting muscarinic antagonists (LAMA)?
a) Nausea
b) Headache
c) Dry mouth
d) Cough

Answer 17

Dry mouth

Question 18

What are the main side effects of long-acting beta agonists (LABAs)?
a) Dry mouth and dizziness
b) Tremor and tachycardia
c) Nausea and vomiting
d) Cough and throat irritation

Answer 18

Tremor and tachycardia

Question 19

Which group in the GOLD 2025 COPD guidelines corresponds to patients with low symptoms (mMRC 0–1 or CAT <10) and no history of frequent exacerbations?
a) Group A
b) Group B
c) Group C
d) Group D

Answer 19

Group A

Question 20

For patients in Group A, what is the recommended initial pharmacological treatment?
a) LAMA
b) LABA
c) A bronchodilator (short-acting or long-acting)
d) ICS + LABA

Answer 20

A bronchodilator (short-acting or long-acting)

Question 21

Patients with mMRC ≥2 or CAT ≥10 and 0–1 moderate exacerbations (not leading to hospital admission) belong to which GOLD group?
a) Group A
b) Group B
c) Group C
d) Group D

Answer 21

Group B

Question 22

What is the initial treatment recommendation for Group B patients?
a) Short-acting bronchodilator
b) Long-acting bronchodilator (LABA or LAMA)
c) ICS + LABA
d) LAMA + LABA

Answer 22

Long-acting bronchodilator (LABA or LAMA)

Question 23

Which GOLD group corresponds to patients with ≥2 moderate exacerbations or ≥1 exacerbation leading to hospitalization and low symptoms (mMRC 0–1 or CAT <10)?
a) Group A
b) Group B
c) Group C
d) Group D

Answer 23

Group C

Question 24

What is the recommended treatment for Group C patients?
a) LABA
b) LAMA
c) LAMA + LABA
d) ICS + LABA

Answer 24

LAMA

Question 25

Patients in Group D have high symptom burden (mMRC ≥2 or CAT ≥10) and ≥2 moderate exacerbations or ≥1 hospitalization. What is the recommended initial treatment?
a) LAMA only
b) LABA only
c) LAMA or LAMA + LABA or ICS + LABA
d) A short-acting bronchodilator

Answer 25

LAMA or LAMA + LABA or ICS + LABA

Question 26

In Group D patients, when should ICS + LABA be considered as an initial treatment?
a) If the patient is highly symptomatic (e.g., CAT >20)
b) If the patient has eosinophil count ≥300
c) Both a and b
d) Neither a nor b

Answer 26

Both a and b

Question 27

What is the only pharmacologic therapy demonstrated to unequivocally decrease mortality in patients with COPD?
a) Long-acting muscarinic antagonists (LAMAs)
b) Inhaled corticosteroids (ICS)
c) Supplemental oxygen
d) Long-acting beta agonists (LABAs)

Answer 27

Supplemental oxygen

Question 28

Which of the following is a criterion for continuous oxygen therapy in patients with COPD?
a) Resting O2 saturation ≤90%
b) Resting O2 saturation ≤88%
c) O2 saturation ≤90% during activity
d) Mild hypoxemia at rest

Answer 28

Resting O2 saturation ≤88%

Question 29

In which situation is supplemental oxygen recommended for COPD patients with an O2 saturation of 89%?
a) When the patient has pulmonary arterial hypertension, right heart failure, or erythrocytosis
b) Only when the patient is exercising
c) When the patient is asymptomatic
d) When the patient has no history of exacerbations

Answer 29

When the patient has pulmonary arterial hypertension, right heart failure, or erythrocytosis

Question 30

Which group of patients is most likely to benefit from lung volume reduction surgery (LVRS)?
A) Patients with lower-lobe predominant emphysema
B) Patients with a high postrehabilitation exercise capacity
C) Patients with upper-lobe predominant emphysema and low postrehabilitation exercise capacity
D) Patients with mild emphysema and normal lung function

Answer 30

Patients with upper-lobe predominant emphysema and low postrehabilitation exercise capacity

Question 31

Which of the following factors is most important for determining a patient’s eligibility for lung volume reduction surgery (LVRS) in emphysema?
A) Age of the patient
B) Anatomic distribution of emphysema and postrehabilitation exercise capacity
C) Duration of the patient’s symptoms
D) Family history of lung disease

Answer 31

Anatomic distribution of emphysema and postrehabilitation exercise capacity