COPD Fitz

Question 1

33. When discussing immunizations with a 67-year-old
    woman with chronic obstructive pulmonary disease
    (COPD), you advise that she:

A. receive live attenuated influenza virus vaccine.
B. avoid immunization against influenza because of the risk associated with the vaccine.
C. receive inactivated influenza virus vaccine.
D. take an antiviral for the duration of the influenza
season.

Answer 1

C. receive inactivated influenza virus vaccine.

Question 2

34. Seasonal influenza vaccination is generally
    recommended for all persons over the age
    of 6 months.

True or False

Answer 2

True

Question 3

35. A 66-year-old woman is an acceptable
    candidate for the high-dose inactivated
    influenza vaccine shot.

True or False

Answer 3

True

Question 4

36. Cigarette smokers should not receive the
    pneumococcal vaccine until 65 years of age.

True or False

Answer 4

False

Question 5

37. A 52-year-old immunocompetent patient with
    COPD who receives the pneumococcal vaccine
    should get revaccinated in 5 years.

True or False

Answer 5

False

Question 6

38. When used in treating COPD, ipratropium bromide
    (Atrovent®) is prescribed to achieve which of the
    following therapeutic effects?
    A. increase mucociliary clearance
    B. reduce alveolar volume
    C. bronchodilation
    D. mucolytic action

Answer 6

C. bronchodilation

Question 7

39. What is the desired therapeutic action of inhaled
    corticosteroids when used to treat COPD?
    A. reversal of fixed airway obstruction
    B. improvement of central respiratory drive
    C. reduction of airway inflammation
    D. mucolytic activity

Answer 7

C. reduction of airway inflammation

Question 8

40. Which is most consistent with the diagnosis of COPD?
    A. FEV1/forced vital capacity (FVC) ratio equal to or
    less than 0.70 after properly timed SABA use
    B. dyspnea on exhalation
    C. elevated diaphragms noted on x-ray
    D. polycythemia noted on complete blood cell count

Answer 8

A. FEV1/forced vital capacity (FVC) ratio equal to or

less than 0.70 after properly timed SABA use

Question 9

41. The most effective nonpharmacologic method to
    prevent exacerbations in patients with COPD is:
    A. weight loss for those with a body mass index (BMI)
    greater than 25 kg/m2.
    B. avoid exposure to children or day-care centers.
    C. brisk walking for at least 5 minutes 3–5 times a day
    as tolerated.
    D. avoid exposure to pulmonary irritants, such as
    cigarette smoke.

Answer 9

D. avoid exposure to pulmonary irritants, such as

cigarette smoke.

Question 10

42. When managing patients with COPD who continue to smoke cigarettes, a discussion on the importance of
    smoking cessation should occur:
    A. at the initial diagnosis visit.
    B. with each COPD flare.
    C. once inhaled corticosteroid therapy is initiated.
    D. at every office visit.

Answer 10

D. at every office visit.

Question 11

43. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD guidelines, which of the following medications is indicated for use in all COPD stages?
A. short-acting inhaled beta2-agonist
B. inhaled corticosteroid
C. phosphodiesterase 4 (PDE-4) inhibitor
D. mucolytic

Answer 11

A. short-acting inhaled beta2-agonist

Question 12

44. According to the GOLD COPD guidelines, the goal of inhaled corticosteroid use in severe COPD is to:
    A. minimize the risk of repeated exacerbations.
    B. improve cough function.
    C. reverse alveolar hypertrophy.
    D. help mobilize secretions.

Answer 12

A. minimize the risk of repeated exacerbations.

Question 13

45. Which of the following systemic corticosteroid doses is most potent?
A. methylprednisolone 8 mg
B. triamcinolone 10 mg
C. prednisone 15 mg
D. hydrocortisone 18 mg

Answer 13

C. prednisone 15 mg

Question 14

46. Which of the following pathogens is often implicated in a COPD exacerbation caused by respiratory tract infection?
A. Legionella species
B. Streptococcus pyogenes
C. respiratory tract viruses
D. Staphylococcus aureus

Answer 14

C. respiratory tract viruses

Question 15

47. Which is the most appropriate choice of therapy in
    the treatment of a mild acute COPD exacerbation in
    a 42-year-old man?
    A. a 5-day course of levofloxacin
    B. a 7-day course of amoxicillin
    C. a 10-day course of doxycycline
    D. antimicrobial therapy usually not indicated

Answer 15

D. antimicrobial therapy usually not indicated

Question 16

48. Which is the most appropriate statement about therapy for a severe COPD exacerbation in a 52-year-old man?
    A. A 5-day course of azithromycin should be prescribed.
    B. A 10-day course of amoxicillin/clavulanate is
    advisable,
    C. A 7-day course of trimethoprim-sulfamethoxazole
    (TMP-SMX) is recommended.
    D. The role of antimicrobial therapy is debated, even
    for a severe exacerbation.

Answer 16

D. The role of antimicrobial therapy is debated, even

for a severe exacerbation.

Question 17

49. You see a 67-year-old man with very severe (GOLD 4) COPD who asks, “When should I use my home oxygen?” You respond:
A. “As needed when short of breath.”
B. “Primarily during sleep hours.”
C. “Preferably during waking hours.”
D. “For at least 15 hours a day.”

Answer 17

D. “For at least 15 hours a day.”

Question 18

50. With a COPD exacerbation, a chest x-ray should be obtained:
    A. routinely in all patients.
    B. when attempting to rule out a concomitant
    pneumonia.
    C. if sputum volume is increased.
    D. when work of breathing is increased.

Answer 18

B. when attempting to rule out a concomitant

pneumonia.

Question 19

51. Which of the following best describes the role of
    theophylline in COPD treatment?
    A. routinely indicated in moderate to very severe
    COPD
    B. use limited by narrow therapeutic profile and
    drug–drug interaction potential
    C. a potent bronchodilator
    D. available only in parenteral form

Answer 19

B. use limited by narrow therapeutic profile and

drug–drug interaction potential

Question 20

52. All of the following are consistent with the GOLD COPD recommendation for pulmonary rehabilitation except:
    A. it is reserved for very severe COPD.
    B. its goals include improvement in overall well-being.
    C. it is an underused therapeutic option.
    D. its components are aimed at reducing the deconditioning common in COPD.

Answer 20

A. it is reserved for very severe COPD.