Question 1

Generally,COPD is BEST diagnosed using which of the following tests?

Accepted Answer

CXR findings are evident only in severe CODP cases.It is of limited value in diagnosing obstructive lung disease.Results of spirometry testing (PFTs)are more important in identifying the presence of most obstructive lung diseases.

Question 2

Which of the following pathological changes results in lung recoil reduction in a patient with chronic inflammation secondary to inhalation of cigarette smoke?

Accepted Answer

Chronic inflammation results in destruction of lung parenchyma,the respiratory bronchioles,and alveoli,leading to loss of alveolar attachments (tethers that hold the airways open),which decrease lung recoil.

Question 3

Cystic fibrosis (CF)is characterized by which of the following statements?

Accepted Answer

CF consists of disease in the conducting airways caused by increased production of secretions or failure to clear secretions.This leads to mucus accumulation in bronchial regions and in bronchioles.Mucus stasis occurs in nasal sinuses,sweat glands,small intestine,pancreas,and biliary system.It is common in Caucasians and is an autosomal recessive trait.

Question 4

Which of the pulmonary function test findings BEST indicates COPD?

Accepted Answer

Pulmonary function test findings indicative of CODP include low FEV₁,low FVC resulting in a decrease in the FEV₁/FVC ratio as lung disease worsens.Individuals with COPD require increased time to expel air from their lungs.Additionally,less air can be exhaled in 1 second.Lung volumes (TLC,RV)increase due to the inability to exhale air.

Question 5

An irreversible dilation of one or more bronchi with chronic inflammation and infection is characterized by which of the following lung diseases?

Accepted Answer

Bronchiectasis is characterized by irreversible dilation of one or more bronchi with chronic inflammation and infection.Bronchiectasis describes an anatomic abnormality rather than a single disease.

Question 6

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD)classification of COPD severity,which of the following stages is associated with a FEV₁ (% predicted)of 30 to 50?

Accepted Answer

Stage III (severe)is associated with an FEV₁ of 30 to 50,FEV₁/FVC of <0.7,chronic cough,sputum,and increased dyspnea.

Question 7

In older children with CF,an enzyme deficiency results in fat and protein maldigestion,producing a distended abdomen and bulky,greasy,foul-smelling stools.This deficiency is associated with which of the following organs?

Accepted Answer

Ninety percent of individuals with CF have pancreatic insufficiency.In infants this insufficiency results in failure to thrive and in older children it results in enzyme deficiency resulting in fat and protein maldigestion.

Question 8

Which of the clinical manifestations distinguishes chronic bronchitis?

Accepted Answer

Chronic bronchitis is defined in clinical terms as the presence of a chronic productive cough for 3 months in each of 2 successive years,provided that other causes of chronic mucus production (CF,bronchiectasis,and TB)have been ruled out.

Question 9

Clinical features of CF include which of the following?

Accepted Answer

The usual clinical presentations in CF include respiratory tract symptoms (persistent cough,recurrent lung infiltrates);GI presentations include meconium ileus and failure to thrive with excessive fat in feces.

Question 10

Which of the following types of emphysema are described as proximal dilation of the respiratory bronchioles,with alveolar ducts and sacs remaining normal?

Accepted Answer

Centrilobular emphysema describes proximal dilation of the respiratory bronchioles,with alveolar ducts and sacs remaining normal.It is most common in the upper lobes and posterior portions of the lung.

Question 11

Increased work of breathing and fatigue in a patient with asthma is BEST explained by which of the following physiological changes?

Accepted Answer

Narrowing of peripheral airways results in premature closure,causing a marked increase in residual volume.The advantage of breathing higher lung volumes is that airways are held open and there is an increase in the elastic recoil of lungs,which increases the driving pressure of exhalation.However,at high thoracic volumes,the diaphragm and intercostal muscles must function over a suboptimal range of their length-tension curve,which increases the work of breathing and fatigue.

Question 12

The finding of hyper-resonant sounds due to lung hyperinflation is associated with which of the following physical examination tests?

Accepted Answer

Hyper-resonant sounds are heard in a COPD patient secondary to lung hyperinflation when a physical therapist performs chest wall percussion.

Question 13

Destruction of alveolar walls and enlargement of the airspaces distal to terminal bronchioles describe which of the following lung conditions?

Accepted Answer

Emphysema is defined as a condition of the lung characterized by destruction of alveolar walls and enlargement of the airspaces distal to the terminal bronchioles.

Question 14

Which of the following conditions is typically associated with bronchiectasis due to traction?

Accepted Answer

Bronchiectasis associated with traction is typically due to lung tissue undergoing fibrotic changes as a result of a restrictive lung disease (sarcoidosis or interstitial fibrosis)or infections such as TB.The airway is pulled outward by local retractile forces resulting in fixed dilation of the airway or traction bronchiectasis.

Question 15

Which of the following physical examination test results is considered a hallmark of asthma?

Accepted Answer

An improvement in FEV₁ of >12% and an increase in FEV₁ of more than 200 mL after bronchodilator administration are considered reversibility of airway obstruction,which is considered a hallmark of asthma.

Question 16

Chronic obstructive pulmonary diseases (COPD)are diseases of the airways that produce obstruction to expiratory airflow.Which of the following problems relates to COPD?

Accepted Answer

COPDs are diseases of the airways that produce expiratory airflow obstruction.Causes of this obstruction include retained secretions,inflammation of the mucosal lining of airway walls,bronchial constriction related to increased tone or spasms of bronchial smooth muscle,and weakening of the support structure of airways walls.

Question 17

Which of the following signs are associated with lung hyperinflation noted in obstructive lung diseases?

Accepted Answer

Common signs of lung hyperinflation associated with obstructive lung diseases included elevation of shoulder girdle,horizontal ribs,barrel-shaped thorax (increased anterior-posterior diameter),and low,flattened diaphragm.

Question 18

In children,a diagnosis of classic CF is partially determined by which of the following sweat test values (sweat chloride concentrations)?

Accepted Answer

In children,chloride concentration levels are usually <40 mEq/L,with average values being 20 mEq/L in normals and 95 mEq/L for those with CF.A milder form of CF,or nonclassic CF,typically has chloride concentrations between 60 and 90 mEq/L.

Question 19

Bronchiectasis characterized by bronchi that are distorted and bulging is more specifically termed which of the following types of bronchiectasis?

Accepted Answer

Varicose or varicoid bronchiectasis is characterized by bronchi that are distorted and bulging,in a similar manner to varicose veins.

Question 20

Which of the following medications are considered long-term controllers of asthma by producing an anti-inflammatory action?

Accepted Answer

Long-term controllers are the inhaled corticosteroids,which are believed to produce benefits through their anti-inflammatory action.Examples include Qvar,Pulmicort,Aerobid,Flovent,Asmanex,and Axmacort.

Quiz 6: Chronic Obstructive Pulmonary Diseases