1
Q
- 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.
A
C. receive inactivated influenza virus vaccine.
2
Q
- Seasonal influenza vaccination is generally
recommended for all persons over the age
of 6 months.
True or False
A
True
3
Q
- A 66-year-old woman is an acceptable
candidate for the high-dose inactivated
influenza vaccine shot.
True or False
A
True
4
Q
- Cigarette smokers should not receive the
pneumococcal vaccine until 65 years of age.
True or False
A
False
5
Q
- A 52-year-old immunocompetent patient with
COPD who receives the pneumococcal vaccine
should get revaccinated in 5 years.
True or False
A
False
6
Q
- 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
A
C. bronchodilation
7
Q
- 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
A
C. reduction of airway inflammation
8
Q
- 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
A
A. FEV1/forced vital capacity (FVC) ratio equal to or
less than 0.70 after properly timed SABA use
9
Q
- 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.
A
D. avoid exposure to pulmonary irritants, such as
cigarette smoke.
10
Q
- 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.
A
D. at every office visit.
11
Q
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
A
A. short-acting inhaled beta2-agonist
12
Q
- 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.
A
A. minimize the risk of repeated exacerbations.
13
Q
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
A
C. prednisone 15 mg
14
Q
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
A
C. respiratory tract viruses
15
Q
- 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
A
D. antimicrobial therapy usually not indicated
16
Q
- 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.
A
D. The role of antimicrobial therapy is debated, even
for a severe exacerbation.
17
Q
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.”
A
D. “For at least 15 hours a day.”
18
Q
- 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.
A
B. when attempting to rule out a concomitant
pneumonia.
19
Q
- 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
A
B. use limited by narrow therapeutic profile and
drug–drug interaction potential
20
Q
- 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.
A
A. it is reserved for very severe COPD.
