COPD

Question 1

What is a key benefit of pulmonary rehabilitation in COPD?

A. Reverses airflow limitation
B. Eliminates need for medication
C. Reduces dyspnoea and hospital admissions
D. Prevents all exacerbations

Answer 1

C

Question 2

Following hospital admission for a COPD exacerbation, pulmonary rehabilitation reduces readmission rates to approximately:

A. 14%
B. 30%
C. 45%
D. 57%

Answer 2

A

Question 3

Slowing respiratory rate in breathing exercises primarily helps by:

A. Increasing inspiratory flow
B. Increasing time for expiration
C. Strengthening accessory muscles
D. Increasing oxygen diffusion

Answer 3

B

Question 4

Current evidence for breathing exercises in stable COPD is:

A. Strongly supportive
B. Moderate and consistent
C. Strong only during exacerbations
D. Limited with no strong evidence

Answer 4

D

Question 5

Airway clearance techniques (ACTs) during acute exacerbation can:

A. Cure airflow limitation
B. Prevent future COPD development
C. Reduce need for ventilatory support
D. Replace bronchodilators

Answer 5

C

Question 6

Alpha-1 antitrypsin deficiency is associated with:

A. Early onset emphysema
B. Chronic bronchitis only
C. Asthma without smoking history
D. Pulmonary fibrosis

Answer 6

A

Question 7

Chronic bronchitis is defined as sputum production for at least:

A. 1 month per year for 2 years
B. 3 months per year for 2 successive years
C. 6 months in one year
D. 3 months total lifetime

Answer 7

B

Question 8

Loss of alveolar walls is indicative of:

A. Bronchiectasis
B. Asthma
C. Chronic bronchitis
D. Emphysema

Answer 8

D

Question 9

Dynamic hyperinflation occurs primarily because:

A. Increased inspiratory capacity
B. Reduced expiratory time during exertion
C. Increased lung compliance
D. Decreased tidal volume

Answer 9

B

Question 10

Gas exchange abnormalities in COPD are largely due to:

A. Increased haemoglobin levels
B. Bronchospasm only
C. V/Q mismatch and increased dead space
D. Reduced cardiac output alone

Answer 10

C

Question 11

Skeletal muscle dysfunction in COPD may be contributed to by:

A. Increased anabolic hormones
B. Reduced inflammation
C. Corticosteroid use
D. Increased activity levels

Answer 11

C

Question 12

Spirometry confirming COPD typically shows:

A. FEV₁/FVC ratio >0.8
B. FEV₁/FVC ratio <0.7
C. Normal lung volumes
D. Increased TLCO

Answer 12

B

Question 13

Non-invasive ventilation (NIV) may be used in COPD patients:

A. To reverse emphysema
B. During chronic respiratory failure or acute exacerbation
C. To replace bronchodilators permanently
D. Only in mild disease

Answer 13

B

Question 14

Alpha-1 antitrypsin deficiency is a recognised cause of COPD. Which statement best describes its clinical significance?
A. It affects the majority of COPD patients and is the second most common cause after smoking
B. It is a genetically inherited disorder affecting a small percentage of the population, associated with early-onset emphysema even without a smoking history
C. It causes predominantly chronic bronchitis rather than emphysema and is triggered by passive smoking
D. It is only clinically significant in patients who are also current smokers

Answer 14

B

Question 15

During a COPD exacerbation, which specific benefit of airway clearance techniques (ACTs) has been demonstrated by evidence?
A. ACTs have been shown to reverse airflow obstruction and improve FEV₁ during acute exacerbations
B. ACTs consistently shorten ICU stay in mechanically ventilated COPD patients
C. ACTs reduce the likelihood of requiring ventilatory support (NIV or intubation) and reduce hospital length of stay
D. ACTs are contraindicated during acute exacerbations due to risk of pneumothorax

Answer 15

C

Question 16

What is the pathophysiological mechanism by which dynamic hyperinflation worsens dyspnoea during exercise in COPD?
A. It causes oxygen desaturation by reducing alveolar surface area for gas exchange
B. Increased flow rates during exercise reduce expiration time; in the presence of expiratory flow limitation this causes further hyperinflation, which further impairs breathing mechanics and intensifies dyspnoea
C. It increases cardiac preload, causing pulmonary oedema and impairing gas exchange
D. It reduces bronchial smooth muscle tone, causing airway collapse on exertion

Answer 16

B

Question 17

Chronic bronchitis has a specific clinical definition. Which of the following correctly defines it?
A. Daily cough with sputum production for at least 3 months per year over 2 consecutive years
B. Airway obstruction with FEV₁/FVC < 0.7 persisting for more than 12 months
C. Sputum production during any acute respiratory illness occurring more than twice per year
D. Chronic cough with wheeze for at least 6 months per year in the absence of asthma

Answer 17

A

Question 18

A chest radiograph of a patient with severe COPD is reviewed. Which radiographic finding is most consistent with significant hyperinflation?
A. Increased peripheral lung markings with an elevated diaphragm
B. Bilateral hilar enlargement with a widened mediastinum
C. Diaphragm intersecting the 11th or 12th rib posteriorly, flattened diaphragm on lateral view, and a narrow heart shadow
D. Consolidation in the lower zones bilaterally with blunting of costophrenic angles

Answer 18

C

Question 19

Which of the following correctly explains why the diaphragm contributes less to ventilation in patients with significant COPD-related hyperinflation?
A. Hyperinflation causes diaphragmatic fibrosis, permanently reducing its contractile function
B. Hyperinflation places the diaphragm in a more shortened, low, flat position which reduces its mechanical advantage and contribution to ventilation
C. The diaphragm is replaced by accessory muscle activity which suppresses diaphragmatic effort via reflex inhibition
D. Elevated PaCO₂ in COPD directly inhibits the phrenic nerve, reducing diaphragmatic drive

Answer 19

B

Question 20

Which spirometric finding is required to confirm airflow obstruction in the diagnosis of COPD?
A. FVC < 80% predicted with a normal FEV₁/FVC ratio
B. FEV₁ < 80% predicted in isolation, regardless of FVC
C. FEV₁/FVC ratio < 0.7 indicating airflow obstruction
D. Increased residual volume with a normal FEV₁/FVC ratio

Answer 20

C

Question 21

Long-term continuous oxygen therapy has been shown to prolong life in patients with severe COPD and hypoxaemia. What is the minimum duration of use per day supported by evidence?
A. At least 8 hours per day, primarily during sleep
B. At least 12 hours per day including exercise periods
C. At least 20 hours per day to suppress hypoxic drive
D. At least 15 hours per day

Answer 21

D

Question 22

A physiotherapist is reviewing evidence for breathing exercises in COPD. Which of the following is the most accurate summary of the current evidence base?
A. Pursed-lip breathing is strongly evidenced and recommended as first-line dyspnoea management in all COPD patients
B. Diaphragmatic breathing has the strongest evidence base of all breathing exercise techniques in COPD
C. There is currently no strong evidence for breathing exercises in COPD, despite various techniques having been trialled
D. Pranayama yoga breathing is supported by high-quality RCT evidence for improving FEV₁ in moderate COPD

Answer 22

C

Question 23

What is the key mechanism by which slowing respiratory rate might reduce hyperinflation and dyspnoea in COPD?
A. A slower respiratory rate increases FiO₂ at the alveolar level, improving gas exchange
B. Slowing RR and increasing expiratory time allows more gas to be exhaled, potentially reducing hyperinflation and therefore dyspnoea
C. Slowing RR activates the parasympathetic nervous system, causing bronchodilation
D. A reduced respiratory rate decreases physiological dead space, improving the VD/VT ratio

Answer 23

B

Question 24

Regarding the epidemiology of COPD, which statement is most accurate?
A. COPD is equally common in smokers and lifelong non-smokers
B. COPD only occurs in those with a significant smoking history and is not seen in non-smokers
C. The prevalence of COPD in developed countries is consistently higher in men than women, with no evidence of changing trends
D. COPD is projected to become the 4th leading cause of death worldwide by 2030, and there is a substantial prevalence in people who have never smoked

Answer 24

D

Question 25

Which pathophysiological change in COPD is directly responsible for increased sputum production combined with reduced mucociliary clearance? A. Loss of alveolar walls and associated capillary bed destruction B. Increase in bronchial smooth muscle causing dynamic airway compression C. Small airway fibrosis reducing inspiratory flow rates D. Mucous gland hypertrophy with increased mucous production, combined with destruction of ciliated epithelial cells in airway walls

Answer 25

D

Question 26

Which of the following best explains how COPD contributes to a reduction in cardiac output during exercise? A. Systemic vasodilation from hypercapnia reduces venous return and left ventricular preload B. Increased pulmonary vascular resistance from hypoxic vasoconstriction reduces right ventricular stroke volume; hyperinflation also reduces venous return, further reducing CO C. Beta-2 agonist bronchodilators used in COPD management directly reduce cardiac contractility D. Skeletal muscle deconditioning reduces metabolic demand on the heart, leading to a compensatory fall in cardiac output

Answer 26

B

Question 27

A patient with COPD attends pulmonary rehabilitation after a hospital admission for an exacerbation. What does evidence suggest about readmission rates compared to those who did not attend? A. Pulmonary rehabilitation reduced readmission rates from 57% to 14% B. Pulmonary rehabilitation reduced readmission rates from 42% to 22% C. Pulmonary rehabilitation had no significant effect on readmission but improved quality of life D. Pulmonary rehabilitation reduced readmission rates from 30% to 10%

Answer 27

A

Question 28

Emphysema is a specific pathological entity within COPD. Which definition is correct? A. Reversible inflammation and oedema of the bronchial walls causing episodic airflow obstruction B. Fibrosis of small airways with consequent fixed narrowing and reduced expiratory flow C. Enlargement of air spaces distal to the terminal bronchiole with destruction of their walls D. Hypertrophy of mucous glands with hypersecretion causing plugging of central airways

Answer 28

C

Question 29

Which of the following correctly explains why the transfer factor for carbon monoxide (TLCO) is reduced in COPD? A. Increased mucous production blocks alveolar pores, preventing CO diffusion B. TLCO reduction in COPD reflects elevated carboxyhaemoglobin levels from smoking history C. Bronchospasm traps CO in small airways, preventing it from reaching alveolar membranes D. TLCO is reduced due to loss of alveolar wall surface area and associated capillary bed destruction, reducing the area available for gas exchange

Answer 29

D

Question 30

During a COPD exacerbation, which physiotherapy intervention should be considered even if the patient does not have excessive secretions? A. High-frequency chest wall oscillation to prevent mucous plug formation B. Incentive spirometry to maintain FVC during bed rest C. Intermittent positive pressure breathing (IPPB) to augment tidal volume D. Early mobilisation and promotion of physical activity to reduce further deconditioning

Answer 30

D

Question 31

Positive expiratory pressure (PEP) devices are a type of airway clearance technique. What does evidence suggest about their effectiveness compared to other ACTs in COPD? A. ACTs that include some form of positive expiratory pressure appear to be more effective than those that do not B. PEP devices are less effective than active cycle of breathing technique (ACBT) in mobilising secretions C. PEP devices are effective only in patients with concomitant bronchiectasis, not in isolated COPD D. PEP devices have equivalent effectiveness to all other ACTs with no evidence of superiority

Answer 31

A

Question 32

Gas exchange abnormalities in COPD arise from alveolar and capillary destruction. Which consequence directly increases the ventilatory burden during exercise? A. Increased physiological dead space (high VD/VT) means greater ventilation is required for a given level of CO₂ production B. Reduced lung compliance requires greater inspiratory muscle force, limiting tidal volume during exercise C. Hypercapnia at rest suppresses central chemoreceptor drive, blunting the ventilatory response to exercise D. Reduced TLCO at rest directly limits cardiac output by preventing adequate O₂ loading onto haemoglobin

Answer 32

A

Question 33

A patient with severe COPD is admitted with an acute exacerbation and rising PaCO₂ with a falling pH. Which medical intervention may be used by the physiotherapy team to help avoid intubation? A. Non-invasive ventilation (NIV) to support ventilation and avoid intubation B. Systemic corticosteroids to reduce airway inflammation and improve airflow C. High-flow nasal cannula oxygen at 60 L/min to maximise FiO₂ delivery D. Nebulised hypertonic saline to aid mucociliary clearance and reduce secretion viscosity

Answer 33

A