Exam: Chronic Obstructive Pulmonary Disease
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Select the best answer to each of the following items.

1. According to the _______, a working definition of COPD is: a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases.
  1. AMA
  2. AARC
  3. ANA
  4. GOLD Report
2. _______ is the only major side-effect of aerosolized steroids.
  1. tachycardia
  2. occasional renal failure in elderly patients
  3. a fungal infection of the oropharynx
  4. transient tachypnea
3. COPD is currently the _______ leading cause of death in the U.S.
  1. first
  2. fourth
  3. tenth
  4. fifteenth
4. According to the GOLD report, many physicians have adopted a nihilistic attitude towards COPD because the prevailing notion that COPD is_______.
  1. curable
  2. incurable
  3. a medical mystery
  4. largely a self-inflicted disease
5. A characteristic symptom of COPD is ­­­­_______.
  1. cough
  2. sputum production
  3. dyspnea upon exertion
  4. all the above
6. COPD has a natural history, _______.
  1. but researchers have yet to discover what it is
  2. and all patients with the disorder follow the same course
  3. but not all individuals follow the same course
  4. and the prognosis is almost always a good one if discovered early
7. The management of COPD _______.
  1. the same for all patients
  2. depends on the age of the patient
  3. is largely symptom driven
  4. is directly determined by the degree of airflow limitation
8. COPD may be diagnosed _______.
  1. only at the onset of its presence
  2. only after the patient has been afflicted for at least 3 months
  3. only after the patient has been afflicted for over a year
  4. at any stage of the illness
9.The common statement that only 15-20% of smokers develop clinically significant COPD _________.
  1. has been confirmed by the Gold report
  2. has been increased to about 30% by the Gold reporte
  3. has been increased to about 75% by the Gold report
  4. is misleading
10.According to the Gold report, the population surveys necessary to develop accurate estimates of COPD prevalence are costly to do _______.
  1. and have not yet begun except in the United States
  2. but have been completed in nearly every country
  3. and therefore have not been conducted in many countries
  4. and therefore should be abandoned
11.The prevalence of COPD is highest in countries where _______ have (has) been, or still is, very common, while the prevalence is lowest in countries where it is less common.
  1. air pollution
  2. industrialization
  3. tuberculosis
  4. cigarette smoking
12. In the United States, the estimated direct cost of COPD is $_______ per COPD patient per year.
  1. 738
  2. 1,002
  3. 1,522
  4. 2,900
13. The best-documented host factor in cases of COPD is a severe hereditary deficiency of _______.
  1. alpha-1 antitrypsin
  2. iron
  3. calcium
  4. surfactant
14. Most common in COPD patients is the _______ form of emphysema, which involves dilatation and destruction of the respiratory bronchioles.
  1. chronic
  2. centrilobular
  3. acute
  4. linear
15. Pulmonary hypertension develops in the _______ stage of COPD.
  1. 0
  2. I
  3. II
  4. III
16. Healthcare workers involved in the diagnosis and management of COPD patients should have access to _______.
  1. sphygmometers
  2. blow-bottles
  3. spirometry
  4. the patient’s medical history
17. Measurement of _______ should be considered in all patients with FEV1 < 40% predicted or clinical signs suggestive of respiratory failure or right heart failure.
  1. flow-volumes
  2. expiratory volumes
  3. inspiratory volumes
  4. arterial blood gas tensions
18. _______ is usually the first symptom of COPD to develop.
  1. Chronic cough
  2. Mucus production
  3. Dyspnea
  4. Wheezing
19. In treating patients with COPD, it is important to consider the presence of concomitant conditions such as ________.
  1. carcinoma
  2. tuberculosis
  3. sleep apnea
  4. all of the above
20. _______ is the single most effective - and cost effective - way to reduce exposure to COPD risk factors.
  1. A health diet
  2. Avoiding occupational dust
  3. Smoking cessation
  4. Daily exercise
21. Counseling delivered by _______ significantly increases quit rates over self-initiated strategies.
  1. former smokers
  2. family members
  3. anti-tobacco advertisements
  4. healthcare professionals
22. _______ medications are central to the symptomatic management of COPD.
  1. Corticosteroid
  2. Bronchodilator
  3. Mucokenic
  4. Allergy
23. Chronic treatment of COPD patients with _______ should be avoided because of an unfavorable benefit-to-risk ratio.
  1. bronchodilators
  2. nicotine patches
  3. systemic glucocorticosteroids
  4. oxygen therapy
24.According to the Gold report, COPD patient education is most effective when it _______.
  1. relies heavily on printed materials
  2. utilizes audio/video materials
  3. is presented one-one-one
  4. it is interactive and conducted in small workshops
25. Of the existing medications for COPD, _______ has been shown to modify the long-term decline in lung function that is the hallmark of this disease.
  1. corticosteroids
  2. bronchodilators
  3. systemic glucocorticosteroids
  4. none
26. Ideally, educational messages should be incorporated into the following aspect of care for COPD: _______. consultations with physicians or other healthcare workers, homecare or outreach programs, and comprehensive pulmonary rehabilitation programs.
  1. consultations with physicians or other health care workers
  2. home-care or outreach programs
  3. comprehensive pulmonary rehabilitation programs
  4. all the above
27. _______ have a relatively rapid onset of bronchodilator effect although this is probably slower in COPD than in asthma.
  1. Inhaled Xanthines
  2. Inhaled corticosteroids
  3. Inhaled ß2-agonists
  4. Systemic glucocorticosteroids
28. According to the Gold report, based on the lack of evidence of benefit, and the large body of evidence on side effects, long-term treatment with _______ is not recommended in COPD.
  1. inhaled B2 agonists
  2. slow-release theophylline
  3. anticholinergics
  4. oral glucocorticosteroids
29. The long-term administration of _______ (> 15 hours per day) to patients with chronic respiratory failure has been shown to increase survival.
  1. bronchodilators
  2. oxygen
  3. systemic glucocorticosteroids
  4. inhaled corticosteroids
30. The step-down approach used in the chronic treatment of _______ is not applicable to COPD since COPD is usually stable and very often progressive.
  1. asthma
  2. bronchitis
  3. lung cancers
  4. emphysema
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