ABSTRACT
(Tick one or more correct answers)
The common presentation in COPD is:
Paroxysmal onset of breathlessness
Night cough
Associated rhinitis and eczema
Cough and sputum for years
History of smoking
Which of the following occurs in COPD?
Eosinophilia
Beta-2-agonist response > 400 ml
FEV1 after oral steroids > 400 ml
Low PEFR and FEV1
The most common reason for patients being unable to stop smoking is:
Lack of will power
Partner smoking
Nicotine addiction
Depression or anxiety
Heart disease
Which of the following does not form part of a brief intervention as set out in the NICE guidelines?
Give the patient self-help material
Refer the patient to a smoking cessation clinic (e.g. NHS stop smoking clinic)
125Offer pharmacotherapy if the patient is unable or unwilling to attend a stop smoking clinic
Tell the patient to stop smoking immediately
Total lung capacity is:
The same as vital capacity
The same as residual volume
Residual volume plus vital capacity
Vital capacity minus residual volume
Functional residual capacity is:
The same as residual volume
The volume of gas in the lungs at the resting expiratory level
The volume of gas expired from the expiration level to maximal expiration
The volume of gas in the lungs at the end of a maximal expiration
Peak flow:
Is a good indicator of asthma control
No asthmatic should be without a peak flow meter
Peak flow is the highest airflow velocity transiently achieved during a forced expiration
Peak flow should be measured after a full inspiration
A patient presents with increasing shortness of breath, cough with green sputum, and is smoking 30 cigarettes a day. Their arterial blood gas analysis is as follows:
pH 7.38
pO2 6kPa
pCO2 7 kPa
Bicarbonate 30 mmol/L
Base excess + 7 mmol/L
The pH is low
There is hypoxaemia and respiratory failure
High bicarbonate levels confirm metabolic compensation
pCO2 is low
126A patient with increasing shortness of breath has the following arterial blood gas analysis:
pO2 8.0 kPa
pCO2 7.3 kPa
pH 7.33
Bicarbonate 26 mmol/L
Base excess + 3 mmol/L
pCO2 is raised
pCO2 is low
This is acidosis
The bicarbonate level is high/normal
The criteria for prescribing long-term oxygen therapy are:
Palliation of dyspnoea in the terminal stage
PaO2 consistently at or below 7.3 kPa when clinically stable
PaO2 consistently between 7.3 and 8.0 when clinically stable and if there is polycythaemia or pulmonary hypertension
Before prescribing, assessment by a chest physician is needed
Common systemic features of COPD include:
Weight gain due to steroid inhaler
Skeletal muscle wasting
Osteoporosis
Anxiety and depression
Theophyllin:
Is effective in exacerbation of COPD
Is metabolised in the liver
Plasma concentration is increased in smokers
Is a bronchodilator used to treat asthma and stable COPD
True assessment of severity should include:
Weight loss
Frequency of exacerbations
Presence of cor pulmonale
Enquiry about how COPD is affecting general daily living
127Frequency of exacerbation is reduced by:
Providing more short-acting inhalers
Inhaled corticosteroids
Stopping the influenza vaccine, as it may trigger an acute attack
Combined long-acting beta agonist and inhaled corticosteroid
Breathlessness developing within minutes is due to:
COPD
Obesity
Acute asthma
Pneumothorax
Pulmonary emboli
Breathlessness developing over a period of years is due to:
COPD
Obesity
Pneumonia
Pulmonary effusion
Cardiac valvular dysfunction
High nicotine dependence is indicated by:
Smoking first cigarette within 6–30 minutes of waking up
Smoking before going to bed
Smoking first cigarette within less than 6 minutes of waking up
Smoking first cigarette within 30–60 minutes of waking up
How many cigarettes smoked daily would be a clue to nicotine dependence?
≤ 10
11–20
21–30
≥ 30
Inhaled corticosteroids are recommended for:
Patients who have two exacerbations within 12 months
All patients with confirmed COPD on spirometry
Breathless patients, in combination with a short-acting beta 2 agonist
128Patients who remain symptomatic despite short- and long-acting bronchodilators
NICE guidelines recommend spirometry:
For initial diagnosis
To see the benefit of inhalers
To prevent exacerbations
For initial diagnosis and then yearly thereafter, unless there is a good response to treatment
For rapid progression of symptoms.
Inaccurate pulse oximetry readings may arise in the following circum stances:
Dark nail varnish on nails
False nails
Poor peripheral perfusion caused by hypotension or cold hand
Presence of carboxyhaemoglobin
Presence of methaemoglobin
Pulse oximetry:
Measurement is made using a probe on the heart
The probe is attached to the finger or ear
Quantifies arterial blood colour by its light absorption
Reading is affected by skin pigmentation
Provides pulse rate, oxygen saturation and peripheral pulse waveform
Functional residual capacity (FRC) is decreased in:
Obstructive airways disease
Obesity
Induction of anaesthesia
Older patients
Supine position
Residual volume (RV):
Is the volume of gas remaining in the lungs at the end of maximal inspiration
Is the volume of gas remaining in the lungs at the end of maximal expiration
129Is normally expressed as a proportion of total lung capacity
Sum of residual volume and vital capacity is total lung capacity
Is low in restrictive pulmonary disease
For bronchodilator reversibility testing:
Ask the patient to take a short-acting beta-agonist for the preceding 4 hours
Ask the patient to take a long-acting agonist and slow-release amino-phylline for 24 hours
Ask the patient to take a short-acting and a long-acting agonist just before coming for the test
The test should be performed before and 20 minutes after administering an inhaled or nebulised beta agonist
The test should be performed when the patient is well
Bronchial hyper-responsiveness test:
Measures the response of the airways to histamine
Response is exaggerated in asthmatic patients
Response is exaggerated in COPD
A normal test is diagnostic of asthma
Absolute contraindication to the test would be an FEV1 value of < 1.21
Causes of restrictive disorder include:
Obesity
Low BMI
Ankylosing spondylitis
Motor neuron disease
Asthma
An obstructive pattern of spirometry is seen in:
Emphysema
COPD
Muscular dystrophy
Pneumonectomy
Pleural effusion
130Consider admitting a patient to hospital with exacerbation when there is:
Rapid rate of onset
Arterial pH < 7.35
Arterial pH > 7.35
Arterial PaO2 < 7 kPa
Peripheral oedema
Common bacterial infections in a patient with purulent sputum include:
Staphylococcus
Haemophilus influenzae
Streptococcus pneumoniae
E. coli
Pseudomonas
Alpha-1-antitrypsin deficiency in COPD:
Is a common cause of COPD
Accounts for 2% of cases
Patients with this deficiency have a slow disease progression
Patients with this deficiency have an aggressive disease progression and a fast decline in lung function
Is genetic and other family members should be screened
Pulmonary rehabilitation involves:
Admitting the patient to hospital for physiotherapy treatment
A multi-disciplinary programme consisting of exercise and education
A waste of resources
Strong evidence that it improves quality of life
The possibility of being undertaken in the patient’s own home
What is the current thinking about which patients should be screened for COPD in general practice?
Over 55 years of age and a smoker
Over 40 years of age and a smoker
Over 35 years of age and a smoker or ex-smoker
Patients who have been exposed to biomass fuels, fumes or coal mining
All low-birthweight patients
131The new home oxygen service for England and Wales:
Was introduced in January 2008
Has never been introduced
Was introduced in February 2006
Was introduced and stopped
Was introduced by local pharmacists
The suggested steroid dose for an exacerbation is:
Prednisolone 30 mg for 5 days
Prednisolone 50 mg for 10 days
Prednisolone 30 mg for 7–10 days, and taper slowly
Prednisolone 30 mg for 7–10 days, with no tapering
Prednisolone 10 mg daily for 7 days and 5 mg maintenance dose
Cough:
Lasting for 8 weeks is called chronic cough
Women are twice as likely to suffer from chronic cough
Common cause is rhinitis
People with reflux cough on first waking up
People with asthma cough on first waking up
Giving smokers an estimate of their lung age:
Doubles their chances of stopping smoking
Is a waste of time
Is an effective way to encourage smokers to take responsibility for their health
Is as effective as nicotine replacement therapy
Is recommended by the NICE guidelines
Relative contraindications to performing spirometry include:
Pneumothorax
Current chest infection
History of myocardial infarction 2 years ago
Unstable angina
History of hypertension
132Complications of spirometry include:
Bronchospasm
Syncope, dizziness and light-headedness
Heart attack
Chest infection
Chest pain
For spirometry:
The patient should lie down
The patient should have done 15 minutes of exercise before the test
The patient should sit erect in a chair with both feet on the floor
The patient should not have consumed a large meal within the last 2 hours
Bronchodilators should be withheld if reversibility testing is to be performed
Normal lung function parameters are as follows:
VC > 80% of predicted value
FVC > 80% of predicted value
FEV1 < 80% of predicted value
FEV1/FVC ratio > 70%
Lung function parameters in combined obstructive and restrictive pattern are as follows:
VC < 80% of predicted value
FVC < 80% of predicted value
FEV1 < 80% of predicted value
FEV1/FVC ratio < 70%
Restrictive pattern:
VC < 80% of predicted value
FVC > 80% of predicted value
FEV1 > 80% of predicted value
FEV1/FVC ratio > 70%
133Common causes of poor spirometry data include:
Cough
Poor coaching
An untrained or poorly trained operator
Leaks between the mouthpiece and the lips
The patient not lying down properly
Obstructive pattern:
VC < 80% of predicted value
FVC < 80% of predicted value
FEV1 < 80% of predicted value
FEV1/FVC ratio < 70%
