COPD Flashcards
What spirometry value confirms airflow obstruction in COPD?
FEV₁/FVC < 0.7.
What is the FEV₁ range for GOLD Stage I (Mild) COPD?
FEV₁ ≥ 80% of the predicted value
What is the FEV₁ range for GOLD Stage II (Moderate) COPD?
FEV₁ is ≥ 50% but < 80% of the predicted value
What is the FEV₁ range for GOLD Stage III (Severe) COPD?
FEV₁ is ≥ 30% but < 50% of the predicted value.
What FEV₁ value defines GOLD Stage IV (Very Severe) COPD?
FEV₁ < 30% of the predicted value.
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
The volume of air exhaled in the first second of a forced expiratory maneuver
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
The total volume of air exhaled during the entire spirometric maneuver
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
A chronically reduced ratio of FEV₁/FVC
What is the most common type of emphysema associated with cigarette smoking?
a) Panlobular emphysema
b) Centrilobular emphysema
c) Paraseptal emphysema
d) Bullous emphysema
Centrilobular emphysema
Which type of emphysema is associated with α1-antitrypsin (α1AT) deficiency?
a) Centrilobular emphysema
b) Panlobular emphysema
c) Paraseptal emphysema
d) Mixed emphysema
Panlobular emphysema
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
Pleural margins with sparing of central lung regions
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
Centrilobular emphysema
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
All of the above
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
Oxygen therapy
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
Lung volume reduction surgery (LVRS)
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
Tiotropium
What is the most frequent side effect of long-acting muscarinic antagonists (LAMA)?
a) Nausea
b) Headache
c) Dry mouth
d) Cough
Dry mouth
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
Tremor and tachycardia
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
Group A
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
A bronchodilator (short-acting or long-acting)
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
Group B
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
Long-acting bronchodilator (LABA or LAMA)
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
Group C
What is the recommended treatment for Group C patients?
a) LABA
b) LAMA
c) LAMA + LABA
d) ICS + LABA
LAMA
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
LAMA or LAMA + LABA or ICS + LABA
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
Both a and b
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)
Supplemental oxygen
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
Resting O2 saturation ≤88%
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
When the patient has pulmonary arterial hypertension, right heart failure, or erythrocytosis
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
Patients with upper-lobe predominant emphysema and low postrehabilitation exercise capacity
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
Anatomic distribution of emphysema and postrehabilitation exercise capacity
A 65-year-old male with a 20-pack-year smoking history presents with complaints of progressive dyspnea and occasional wheezing. Spirometry reveals a post-bronchodilator FEV1/FVC ratio of 0.65 and FEV1 of 55% predicted. Over the past year, he has had one moderate exacerbation not requiring hospitalization. His mMRC score is 2, and his CAT score is 12. Based on the GOLD ABE assessment tool, what is the most appropriate initial pharmacological treatment for this patient?
A) A bronchodilator
B) LABA + LAMA
C) LABA + LAMA + ICS
D) LAMA monotherapy
Correct Answer:
B) LABA + LAMA
Rationale:
The patient’s post-bronchodilator FEV1/FVC ratio of 0.65 confirms COPD (diagnosis threshold: <0.7).
His FEV1 of 55% predicted places him in GOLD Grade 2.
The exacerbation history (one moderate exacerbation not requiring hospitalization) and symptom scores (mMRC = 2, CAT = 12) categorize him into Group B in the GOLD ABE assessment tool.
According to the guidelines, patients in Group B should be treated with dual bronchodilation (LABA + LAMA).
LABA + LAMA + ICS (Option C) is reserved for cases with high eosinophil counts or frequent exacerbations (≥2 per year or ≥1 hospitalization).
A bronchodilator (Option A) or LAMA monotherapy (Option D) is insufficient for Group B patients who have higher symptom burdens (mMRC ≥2 or CAT ≥10).
A 55-year-old male with COPD is classified as GOLD Grade 4 with an FEV1 of 28% predicted. He has had one moderate exacerbation in the past year, which did not lead to hospitalization. His CAT score is 8, and his mMRC score is 1. Based on the GOLD ABE assessment tool, which group does this patient belong to?
A) Group A
B) Group B
C) Group E
D) Group D
Correct Answer:
A) Group A
Rationale:
The patient’s FEV1 of 28% predicted places him in GOLD Grade 4, indicating severe airflow obstruction.
His exacerbation history (one moderate exacerbation not requiring hospitalization) and symptom burden (mMRC = 1, CAT = 8) categorize him as Group A.
Group A patients are characterized by low exacerbation risk (0–1 exacerbations not requiring hospitalization) and minimal symptoms (mMRC 0–1, CAT <10).
What is the recommended duration of systemic glucocorticoid therapy for outpatient management of COPD exacerbations?
A) 2–3 days
B) 5–10 days
C) 4–6 weeks
D) 8 weeks
Correct Answer: B) 5–10 days
Rationale: Studies have shown that a 5–10 day course of systemic glucocorticoids (e.g., prednisolone 30–40 mg daily) is effective in reducing exacerbation severity without the risks associated with prolonged use.
What is the target oxygen saturation when providing supplemental oxygen in acute COPD exacerbations?
A) ≥85%
B) ≥90%
C) ≥95%
D) 100%
Correct Answer: B) ≥90%
Rationale: The goal of oxygen therapy is to maintain saturation at or above 90% while avoiding excessive oxygenation, which can lead to hypercapnia in COPD patients.
Which of the following is NOT a contraindication to noninvasive positive-pressure ventilation (NIPPV) in acute COPD exacerbations?
A) Cardiovascular instability
B) Impaired mental status
C) Mild respiratory acidosis
D) Copious secretions
Correct Answer: C) Mild respiratory acidosis
Rationale: NIPPV is indicated for respiratory failure (PaCO₂ >45 mmHg) and can help correct mild to moderate acidosis. However, severe conditions such as cardiovascular instability, impaired mental status, or an inability to clear secretions are contraindications.
Which of the following factors should be considered when managing mechanical ventilation in patients with COPD exacerbations?
A) Avoiding auto-PEEP (positive end-expiratory pressure)
B) Targeting an FiO₂ of 100%
C) Using high tidal volumes to improve oxygenation
D) Increasing inspiratory time to maximize ventilation
Correct Answer: A) Avoiding auto-PEEP (positive end-expiratory pressure)
Rationale: Patients with COPD are at risk for auto-PEEP due to airflow obstruction. Avoiding excessive PEEP and ensuring adequate expiratory time is critical in mechanical ventilation.
At what level of FEV₁ reduction does resting arterial oxygen pressure (PaO₂) typically become abnormal in COPD?
A) <75% of predicted
B) <50% of predicted
C) <35% of predicted
D) <25% of predicted
Correct Answer: B) <50% of predicted
Rationale: In COPD, PaO₂ usually remains normal until FEV₁ falls below 50% of predicted values, after which hypoxemia becomes more common.
