[MCQ] Chronic Obstructive Pulmonary Disease- Part 2

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Chronic Obstructive Pulmonary Disease- Part 2

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Congratulations - you have completed Chronic Obstructive Pulmonary Disease- Part 2. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

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Question 1

Which of the following is the most typical finding in COPD ?

A	Increase in the residual volume
B	Persistent reduction in forced expiratory flow rates
C	Increase in residual volume/total lung capacity ratio
D	Nonuniform distribution of ventilation

Question 1 Explanation:

Persistent reduction in forced expiratory flow rates is the most typical finding in COPD. Increases in residual volume & RV/TLC ratio, nonuniform distribution of ventilation & ventilation-perfusion mismatching also occur

Question 2

In COPD, at rest, PaO2 usually remains near normal until the FEV1 is decreased to ?

A	~ 25 % of predicted
B	~ 33 % of predicted
C	~ 50 % of predicted
D	~ 75 % of predicted

Question 2 Explanation:

PaO2 usually remains near normal until the FEV1 is decreased to ~50% of predicted at rest

Question 3

In COPD, PaCO2 usually remains near normal until the FEV1 is decreased to ?

A	~ 25 % of predicted
B	~ 33 % of predicted
C	~ 50 % of predicted
D	~ 75 % of predicted

Question 3 Explanation:

In COPD, elevation of PaCO2 is not expected until FEV1 is <25% of predicted

Question 4

Pulmonary hypertension leading to cor pulmonale & CHF due to COPD occurs in those with FEV1 (<25% of predicted) and ?

A	Chronic hypoxemia (PaO2 < 75 mmHg)
B	Chronic hypoxemia (PaO2 < 65 mmHg)
C	Chronic hypoxemia (PaO2 < 55 mmHg)
D	Chronic hypoxemia (PaO2 < 45 mmHg)

Question 4 Explanation:

PHT severe enough to cause cor pulmonale & RVF due to COPD occurs only in those who have marked decreases in FEV 1 (<25% of predicted) together with chronic hypoxemia (PaO2 <55 mmHg)

Question 5

Which of the following accounts most for the reduction in PaO2 that occurs in COPD ?

A	Bronchospasm
B	Shunting
C	Ventilation / perfusion mismatching
D	Bronchial tree plugging

Question 5 Explanation:

Ventilation/perfusion mismatching accounts for all of the reduction in PaO2 that occurs in COPD. Shunting is minimal

Question 6

Which of the following is responsible for physiologic alterations that occur with COPD ?

A	Large airways
B	Medium airways
C	Small airways and alveolar space
D	All of the above

Question 6 Explanation:

Changes in large airways cause cough and sputum, while changes in small airways and alveoli are responsible for physiologic alterations

Question 7

Which of the following is responsible for increased resistance in most individuals with COPD ?

A	Large airways
B	Medium airways
C	Small airways
D	All of the above

Question 7 Explanation:

Major site of increased resistance in COPD is in airways <=2 mm diameter.

Question 8

Cells secreting surfactant are called ?

A	Kulchitsky cell
B	Clara cell
C	Langerhans cell
D	C cell

Question 8 Explanation:

In COPD, characteristic cellular changes include goblet cell metaplasia, with these mucus-secreting cells replacing surfactant-secreting Clara cells. Reduced surfactant may increase surface tension at the air-tissue interface, predisposing to airway narrowing or collapse

Question 9

Gas exchanging airspaces include ?

A	Respiratory bronchiole
B	Alveolar duct
C	Alveoli
D	All of the above

Question 9 Explanation:

Gas-exchanging airspaces are respiratory bronchioles, alveolar ducts and alveoli. Emphysema is characterized by destruction of all these three.

Question 10

Which of the following is false in smokers ?

A	In BAL fluid, macrophages are > 95% of total cell count
B	Neutrophils account for 1 to 2 % of cells
C	CD8+ T lymphocytes are increased in alveolar space
D	None of the above

Question 10 Explanation:

In smokers’ BAL fluid, macrophages comprise >95% of the total cell count, and neutrophils, nearly absent in nonsmokers’ lavage, account for 1–2% of the cells. CD8+ lymphocytes are also increased in alveolar space of smokers

Question 11

Which of the following is false ?

A	Panacinar emphysema is seen in  AT deficiency
B	Centriacinar emphysema is seen in cigarette smokers
C	Panacinar emphysema has predilection for upper lobes
D	Centriacinar emphysema is most prominent in the upper lobes and superior segments of lower lobes

Question 11 Explanation:

Panacinar emphysema is usually observed in patients with alpha1AT deficiency, and has a predilection for the lower lobes.

Question 12

Principal feature of advancing COPD is ?

A	Worsening dyspnea on exertion
B	Cough
C	Sputum production
D	All of the above

Question 12 Explanation:

Three most common symptoms in COPD are cough, sputum production & exertional dyspnea. As COPD advances, the principal feature is worsening dyspnea on exertion.

Question 13

Sitting in “tripod” position, facilitates action of which of the following muscles ?

A	Sternocleidomastoid muscle
B	Scalene muscle
C	Intercostal muscles
D	All of the above

Question 13 Explanation:

Use of accessory muscles of respiration is done by sitting in characteristic “tripod” position that facilitates the actions of sternocleidomastoid, scalene, and intercostal muscles.

Question 14

Which of the following is a poor prognostic factor in COPD ?

A	Diffuse loss of subcutaneous adipose tissue
B	Significant weight loss
C	Bitemporal wasting
D	All of the above

Question 14 Explanation:

Independent poor prognostic factors in advanced COPD are systemic wasting, significant weight loss, bitemporal wasting & diffuse loss of subcutaneous adipose tissue

Question 15

Systemic wasting in advanced COPD is related to ?

A	Neutrophil elastase
B	Matrix metalloproteinase-12 (MMP-12)
C	TNF-
D	Transforming growth factor  (TGF-)

Question 15 Explanation:

Systemic wasting in advanced COPD is related to both inadequate oral intake and elevated levels of inflammatory cytokines (TNF-)

Question 16

In COPD, Hoover’s sign refers to ?

A	Use of accessory muscles
B	Pursed-lip breathing
C	Diffuse loss of subcutaneous adipose tissue
D	Paradoxical inward movement of rib cage with inspiration

Question 16 Explanation:

Hoover’s sign refers to paradoxical inward movement of rib cage with inspiration.

Question 17

In COPD, Hoover’s sign refers to ?

A	Use of accessory muscles
B	Pursed-lip breathing
C	Diffuse loss of subcutaneous adipose tissue
D	Paradoxical inward movement of rib cage with inspiration

Question 17 Explanation:

Hoover’s sign refers to paradoxical inward movement of rib cage with inspiration.

Question 18

Which of the following is not a sign of COPD ?

A	Expiratory wheezing
B	Bitemporal wasting
C	Clubbing of the digits
D	Right heart failure

Question 18 Explanation:

Clubbing of the digits is not a sign of COPD, and its presence should alert the clinician to rule out lung cancer or else.

Question 19

Which of the following is the basis for Gold criteria for COPD severity ?

A	Airflow obstruction
B	Exercise performance
C	Arterial blood gases and oximetry
D	Body mass index

Question 19 Explanation:

The hallmark and important prognostic factor of COPD is airflow obstruction and is the basis for the Global Initiative for Lung Disease (GOLD) classification for COPD severity.

Question 20

Which of the following interventions does not influence the natural history of patients with COPD ?

A	Antibiotics
B	Smoking cessation
C	Oxygen therapy in chronically hypoxemic patients
D	Lung volume reduction surgery

Question 20 Explanation:

Only three interventions i.e.smoking cessation, oxygen therapy in chronically hypoxemic patients, and lung volume reduction surgery in selected patients with emphysema influence the natural history of patients with COPD.

Question 21

Cigarette smoking increases risk for which of the following ?

A	Atherosclerotic vascular disease
B	Osteoporosis
C	Peptic ulcer disease
D	All of the above

Question 21 Explanation:

Cigarette smoking increases atherosclerotic vascular disease risk, osteoporosis & peptic ulcer disease

Question 22

The other action of ‘Bupropion’ used in nicotine replacement therapy is ?

A	Antihypertensive
B	Antidepressant
C	Anticholinergic
D	Analgesic

Question 22 Explanation:

Antidepressant bupropion is shown to be effective in smoking cessation.

Question 23

Bupropion use is contraindicated in patients of ?

A	Diabetes mellitus
B	Hypertension
C	Seizure
D	Hypothryoidism

Question 23 Explanation:

Bupropion is contraindicated in those with increased risk of seizures.

Question 24

Which of the following drugs have been found useful in smoking cessation ?

A	Clonidine
B	Nortriptyline
C	Varenicline
D	All of the above

Question 24 Explanation:

Clonidine & tricyclic antidepressant nortriptyline have been found useful in smoking cessation as second-line treatments. Varenicline is an  42 nicotinic acetylcholine receptor partial agonist

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See all quizzes of Obstructive Pulmonary Disease at here:

Chronic Obstructive Pulmonary Disease- Part 1| Chronic Obstructive Pulmonary Disease- Part 2 | Chronic Obstructive Pulmonary Disease- Part 3

1.Which of the following is the most typical finding in COPD ?
A. Increase in the residual volume
B. Persistent reduction in forced expiratory flow rates
C. Increase in residual volume/total lung capacity ratio
D. Nonuniform distribution of ventilation

2. In COPD, at rest, PaO2 usually remains near normal until the FEV1 is decreased to ?
A. ~ 25 % of predicted
B. ~ 33 % of predicted
C. ~ 50 % of predicted
D. ~ 75 % of predicted

2. In COPD, PaCO2 usually remains near normal until the FEV1 is decreased to ?
A. ~ 25 % of predicted
B. ~ 33 % of predicted
C. ~ 50 % of predicted
D. ~ 75 % of predicted

3. Pulmonary hypertension leading to cor pulmonale & CHF due to COPD occurs in those with FEV 1 (<25% of predicted) and ?

A. Chronic hypoxemia (PaO2 < 75 mmHg)
B. Chronic hypoxemia (PaO2 < 65 mmHg)
C. Chronic hypoxemia (PaO2 < 55 mmHg)
D. Chronic hypoxemia (PaO2 < 45 mmHg)

4. Which of the following accounts most for the reduction in PaO2 that occurs in COPD ?
A. Bronchospasm
B. Shunting
C. Ventilation / perfusion mismatching
D. Bronchial tree plugging

5. Which of the following is responsible for physiologic alterations that occur with COPD ?
A. Large airways
B. Medium airways
C. Small airways and alveolar space
D. All of the above

6. Which of the following is responsible for increased resistance in most individuals with COPD ?
A. Large airways
B. Medium airways
C. Small airways
D. All of the above

7. Cells secreting surfactant are called ?
A. Kulchitsky cell
B. Clara cell
C. Langerhans cell
D. C cell

8. Gas exchanging airspaces include ?
A. Respiratory bronchiole
B. Alveolar duct
C. Alveoli
D. All of the above

9. Which of the following is false in smokers ?
A. In BAL fluid, macrophages are > 95% of total cell count
B. Neutrophils account for 1 to 2 % of cells
C. CD8+ T lymphocytes are increased in alveolar space
D. None of the above

10. Which of the following is false ?
A. Panacinar emphysema is seen in  AT deficiency
B. Centriacinar emphysema is seen in cigarette smokers
C. Panacinar emphysema has predilection for upper lobes
D. Centriacinar emphysema is most prominent in the upper
lobes and superior segments of lower lobes
11. Principal feature of advancing COPD is ?
A. Worsening dyspnea on exertion
B. Cough
C. Sputum production
D. All of the above

12. Sitting in “tripod” position, facilitates action of which of the following muscles ?
A. Sternocleidomastoid muscle
B. Scalene muscle
C. Intercostal muscles
D. All of the above

13. Which of the following is a poor prognostic factor in COPD ?
A. Diffuse loss of subcutaneous adipose tissue
B. Significant weight loss
C. Bitemporal wasting
D. All of the above

14. Systemic wasting in advanced COPD is related to ?
A. Neutrophil elastase
B. Matrix metalloproteinase-12 (MMP-12)
C. TNF-
D. Transforming growth factor  (TGF-)

15. In COPD, Hoover’s sign refers to ?
A. Use of accessory muscles
B. Pursed-lip breathing
C. Diffuse loss of subcutaneous adipose tissue
D. Paradoxical inward movement of rib cage with inspiration

16. Which of the following is not a sign of COPD ?
A. Expiratory wheezing
B. Bitemporal wasting
C. Clubbing of the digits
D. Right heart failure

17. Which of the following is the basis for Gold criteria for COPD severity ?
A. Airflow obstruction
B. Exercise performance
C. Arterial blood gases and oximetry
D. Body mass index

18. Which of the following interventions does not influence the natural history of patients with COPD ?
A. Antibiotics
B. Smoking cessation
C. Oxygen therapy in chronically hypoxemic patients
D. Lung volume reduction surgery
19. Cigarette smoking increases risk for which of the following ?
A. Atherosclerotic vascular disease
B. Osteoporosis
C. Peptic ulcer disease
D. All of the above

20. The other action of ‘Bupropion’ used in nicotine replacement therapy is ?
A. Antihypertensive
B. Antidepressant
C. Anticholinergic
D. Analgesic

22. Bupropion use is contraindicated in patients of ?
A. Diabetes mellitus
B. Hypertension
C. Seizure
D. Hypothryoidism

23. Which of the following drugs have been found useful in smoking cessation ?
A. Clonidine
B. Nortriptyline
C. Varenicline
D. All of the above

Chronic Obstructive Pulmonary Disease

[MCQ] Chronic Obstructive Pulmonary Disease- Part 2

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Chronic Obstructive Pulmonary Disease- Part 2

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[MCQ] Chronic Obstructive Pulmonary Disease- Part 1

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