Dyspnoea

Question 1

The SGRQ-C differs from the full SGRQ in that it:
A. Is validated for all chronic respiratory diseases
B. Is a shortened version validated for COPD only
C. Has 100 items
D. Focuses exclusively on exercise tolerance

Answer 1

B

Question 2

Platypnoea is best described as:
A. Dyspnoea in the supine position relieved by sitting
B. Dyspnoea occurring in one lateral decubitus position
C. Dyspnoea that occurs upright and is relieved with recumbency
D. Dyspnoea on exertion only

Answer 2

C

Question 3

Orthopnoea is characterized by:
A. Dyspnoea relieved by sitting upright
B. Dyspnoea occurring during exercise only
C. Dyspnoea during early morning
D. Dyspnoea only in lateral decubitus position

Answer 3

A

Question 4

Paroxysmal nocturnal dyspnoea (PND) typically occurs:
A. Immediately upon standing
B. During vigorous exercise
C. 1–2 hours after sleep and relieved by upright posture
D. Only in children

Answer 4

C

Question 5

Which patient population is most likely to present with slow-onset dyspnoea on exhalation?
A. ILD
B. Asthma and COPD
C. Pneumothorax
D. Deconditioning

Answer 5

B

Question 6

In dyspnoea assessment, the MRC Dyspnoea Scale grade 3 indicates:
A. Not troubled except on vigorous exertion
B. Walks slower than contemporaries or needs to stop when walking at own pace
C. Stops for breath after ~100m or a few minutes on flat
D. Too breathless to leave the house

Answer 6

B

Question 7

A major feature of dyspnoea in hyperventilation or dysfunctional breathing is:
A. Relief with rest
B. Air hunger not relieved by rest
C. Positional dependency
D. Only during sleep

Answer 7

B

Question 8

Which breathing method requires nasal breathing, stress reduction, and regular independent practice?
A. Box breathing
B. Buteyko method
C. Pursed-lip breathing
D. ACBT breathing control

Answer 8

B

Question 9

A patient with dyspnoea due to obesity is most likely to present with:
A. Exertional dyspnoea
B. Paroxysmal nocturnal dyspnoea
C. Dyspnoea only at rest
D. Dyspnoea only when supine

Answer 9

A

Question 10

Which of the following statements about dyspnoea in ILD is correct?
A. Slow onset, mainly on exhalation
B. Progressive and exertional
C. Relieved immediately by rest
D. Only positional

Answer 10

B

Question 11

In COPD patients with increased closing volume, which technique is particularly effective?
A. Buteyko breathing
B. Pursed-lip breathing
C. Box breathing
D. Rapid shallow breathing

Answer 11

B

Question 12

A patient performing ACBT always begins with:
A. Huffing
B. Breathing control
C. Forced expiration technique
D. Pursed-lip exhalation

Answer 12

B

Question 13

Trepopnoea is defined as:
A. Dyspnoea occurring upright
B. Dyspnoea in one lateral decubitus position but not the other
C. Dyspnoea in supine position relieved by sitting
D. Dyspnoea only during exertion

Answer 13

B

Question 14

Which dyspnoea type is relieved by sitting upright?
A. Platypnoea
B. Orthopnoea
C. Trepopnoea
D. Exertional dyspnoea

Answer 14

B

Question 15

Which intervention is most appropriate for a patient too breathless to speak during activity?
A. Box breathing
B. Pursed-lip breathing and supportive positioning
C. Buteyko exhalation holds
D. Unassisted high-intensity exercise

Answer 15

B

Question 16

The Papworth Method primarily targets:
A. Structural correction of chest wall
B. Relaxation and controlled breathing
C. Increasing closing volume
D. Forced exhalation only

Answer 16

B

Question 17

A patient with COPD tells you their breathlessness wakes them from sleep, usually after 1–2 hours, and is relieved when they sit upright. Which type of dyspnoea does this describe?
A. Orthopnoea
B. Platypnoea
C. Trepopnoea
D. Paroxysmal nocturnal dyspnoea (PND)

Answer 17

D

Question 18

What is the target level of perceived exertion on the Modified Borg Scale during exercise in pulmonary rehabilitation?
A. 1 — very light
B. 3 — moderate
C. 5 — strong
D. 7 — very strong

Answer 18

B

Question 19

The SGRQ-C is a shortened version of the St George’s Respiratory Questionnaire. For which condition is it exclusively validated?
A. Asthma and COPD
B. Interstitial lung disease and sarcoidosis
C. COPD only
D. Bronchiectasis and pulmonary hypertension

Answer 19

C

Question 20

Which MRC Dyspnoea Scale grade correctly describes a patient who stops for breath after walking approximately 100 metres on the flat?
A. Grade 2
B. Grade 3
C. Grade 4
D. Grade 5

Answer 20

C

Question 21

A patient with hyperventilation syndrome reports air hunger that is not relieved by rest. Which dyspnoea presentation pattern is most consistent with dysfunctional breathing?
A. Positional and on exhalation, improving in the upright position
B. Progressive and exertional, worsening over months
C. Air hunger not relieved by rest, consistent with dysfunctional breathing/hyperventilation
D. Slow onset and episodic, predominantly on exhalation

Answer 21

C

Question 22

Which of the following conditions is NOT listed as a validated application of the full SGRQ (not SGRQ-C)?
A. Pulmonary leiomyomatosis
B. Post-tuberculosis lung disease
C. Cystic fibrosis
D. Sarcoidosis

Answer 22

C

Question 23

What is the physiological mechanism by which pursed lip breathing is thought to be particularly beneficial in patients with chronic lung disease and increased closing volume?
A. It slows inspiratory flow rate, allowing more even distribution of ventilation to underventilated lung units
B. It recruits the diaphragm more effectively by creating a back-pressure that splints the thorax during exhalation
C. The expiratory phase creates positive pressure within the respiratory airways, promoting stability and inflation of alveoli and collateral airways, preventing premature airway closure
D. It activates the Hering-Breuer reflex, prolonging expiratory time and reducing dynamic hyperinflation via central inhibition of inspiration

Answer 23

C

Question 24

A patient with an MRC Dyspnoea Scale score of 5 presents to clinic. Which description most accurately reflects their functional limitation?
A. Breathless when hurrying on the flat or walking up a slight incline
B. Walks slower than peers on the flat due to breathlessness or needs to stop to catch breath at own pace
C. Stops for breath after approximately 100 metres or after a few minutes on the flat
D. Too breathless to leave the house, or becomes breathless when dressing or undressing

Answer 24

D

Question 25

The Buteyko method is based on three core principles. Which option correctly identifies all three? A. Nasal breathing, stress reduction, and maintenance of good health B. Diaphragmatic breathing, pacing strategies, and energy conservation C. Pursed lip breathing, box breathing, and respiratory muscle training D. Controlled ventilation, oxygen supplementation, and breathing pattern retraining

Answer 25

A

Question 26

In the box breathing technique, what is the correct sequence and timing for each phase? A. Inhale for 4, exhale for 4, hold for 4, pause for 4 — performed in high sitting B. Inhale for 4, hold for 4, release breath (not forcefully) for 4, pause for 4 — ideally through the nose in a calm environment C. Inhale for 6, hold for 2, exhale for 6, pause for 2 — adjusted to patient's natural breathing rate D. Inhale for 4, hold for 7, exhale for 8 — used primarily for acute anxiety and dysfunctional breathing episodes

Answer 26

B

Question 27

Which dyspnoea type is characterised by breathlessness occurring specifically in one lateral decubitus position but not the other? A. Orthopnoea B. Paroxysmal nocturnal dyspnoea C. Trepopnoea D. Platypnoea

Answer 27

C

Question 28

Which statement about ACBT breathing control is correct, and what is its primary role within the cycle? A. Breathing control uses deep, slow breaths at twice normal tidal volume to maximise alveolar recruitment between active techniques B. Breathing control uses normal tidal volume, promotes relaxation, prevents hyperventilation, and ACBT always starts with breathing control C. Breathing control is performed at the end of ACBT only, to consolidate secretion movement before a final huff D. Breathing control uses pursed lip breathing to maintain positive expiratory pressure between active components of the cycle

Answer 28

B

Question 29

A patient with interstitial lung disease describes their dyspnoea. Which presentation pattern is most consistent with ILD? A. Episodic, predominantly on exhalation, with slow onset over days B. Positional, worse lying flat, associated with bilateral wheeze on exhalation C. Severe and sudden in onset, associated with pleuritic chest pain on inspiration D. Progressive and exertional, worsening gradually over months to years

Answer 29

D

Question 30

The Modified Borg Scale is described as a well-validated outcome measure in pulmonary rehabilitation. Which additional feature makes it particularly practical for clinical use during exercise sessions? A. It correlates directly with FEV₁ % predicted, providing objective physiological validation of patient-reported effort B. It can be used at any time during activity, allowing real-time monitoring of exertion levels throughout an exercise session C. It requires no patient instruction as ratings are based on observed breathing pattern rather than self-report D. It has been validated exclusively in pulmonary rehabilitation and is not appropriate for other clinical settings

Answer 30

B

Question 31

Which assessment finding would NOT typically be included in a clinical dyspnoea assessment? A. Spirometry FEV₁/FVC ratio and bronchodilator reversibility B. Chest wall movement and nasal or oral breathing pattern C. Respiratory rate and use of accessory muscles D. Pulse oximetry and pallor

Answer 31

A

Question 32

Platypnoea is the least commonly discussed type of dyspnoea. Which description correctly defines it? A. Breathlessness occurring in the recumbent position, relieved by sitting upright B. Breathlessness occurring in the upright position, relieved by recumbency C. Breathlessness occurring only during strenuous exertion in otherwise healthy individuals D. Breathlessness awakening the patient from sleep, usually relieved by sitting upright

Answer 32

B

Question 33

What is the key principle behind energy conservation strategies in managing dyspnoea, particularly regarding patient positioning? A. Supported positions are used, and if the patient relies on accessory muscles, they should be positioned to allow continued use — for example, with support through the shoulder girdle B. Patients should be placed supine to minimise oxygen demand by reducing postural muscle activity entirely C. Energy conservation requires all activities to be performed in bed rest to prevent exertional desaturation D. Patients should be discouraged from using accessory muscles as this increases metabolic demand and worsens dyspnoea

Answer 33

A

Question 34

Dyspnoea associated with pulmonary oedema has a characteristic presentation pattern. Which description is most consistent with this condition? A. Progressive and exertional over months, not related to position or time of day B. Sudden severe onset associated with unilateral pleuritic chest pain C. Episodic breathlessness on exhalation, precipitated by allergen exposure D. Positional dyspnoea with a component on exhalation, often worsening in recumbency

Answer 34

D

Question 35

The mechanism of dyspnoea is described as multifactorial. Which combination of factors is listed as playing an important role? A. Functional status of respiratory muscles, mechanical and chemical afferents, and central motor output — alongside a heightened awareness of respiratory sensation with a strong emotional component B. Arterial oxygen saturation, peak expiratory flow rate, and inspiratory muscle strength — with dyspnoea severity directly proportional to degree of hypoxia C. Respiratory rate, tidal volume, and diaphragmatic excursion — with emotional factors playing no role in the mechanistic pathway D. Chemoreceptor sensitivity, bronchomotor tone, and V/Q mismatch — with dyspnoea severity correlating directly with PaCO₂ levels

Answer 35

A