Pharmacological Interventions
Surgical Interventions
Lifestyle Interventions
Special Tests
Bedside Tests, Imaging + Pathology
100
Which two classes of bronchodilators are used in the initial step of COPD treatment, and how are they administered?
Short-acting beta2-agonists (SABA, e.g., salbutamol) and short-acting muscarinic antagonists (SAMA, e.g., ipratropium bromide), administered via inhalation (MDI, DPI, nebulizer).
100
True or False: Pulmonary rehabilitation is a required pre-surgery step for procedures like bullectomy and lung volume reduction surgery (LVRS).
TRUE.
100
What is the most important lifestyle intervention to slow COPD progression?
Smoking cessation is the most important intervention, as it reduces the rate of lung function decline and decrease exacerbations.
100
True or False: DLCO is the primary investigation used to diagnose COPD.
False
100
True or False - most asthma patients present with a normal CXR.
TRUE.
200
What factors determine whether a patient should be started on a combination LAMA/LABA therapy instead of monotherapy?
The need for LAMA/LABA combination depends on the patient’s symptomatic response to initial bronchodilator therapy. If symptoms persist despite single-agent LABA or LAMA, a combination therapy is considered for better symptom control.
200
Which of the following best describes bullectomy?
a) The removal of large bullae that press on healthy alveoli
b) The removal of the upper portions of both lungs
c) The placement of valves in the airways to collapse non-working lung portions
d) A complete lung transplant
A
200
What are the two main components of an effective smoking cessation strategy, and how do they help with nicotine dependence?
A combination of behavioral support and pharmacotherapy is most effective. Behavioral support helps address psychological triggers, while nicotine replacement therapy (e.g., patches, gums) provides controlled nicotine doses to reduce withdrawal symptoms and cravings.
200
Why is the FVC value decreased in restrictive lung disease?
Due to lung tissue stiffness (e.g. pulmonary fibrosis can cause lung tissue to become siff and less elastic, preventing full expansion).
200
What is a common bedside test used to easily measure lung function and assess airway obstruction?
Peak Flow Meter
300
Why might phosphodiesterase-4 (PDE-4) inhibitors be considered in severe COPD, and what is their mechanism of action?
PDE-4 inhibitors (e.g., roflumilast) are used in severe COPD to reduce inflammation and relax airways. They work by inhibiting the PDE-4 enzyme, decreasing inflammatory mediators, and preventing exacerbations in patients with chronic bronchitis.
300
Which of the following patients would NOT be a good candidate for a lung transplant?
a) A 65-year-old with severe emphysema and no other health issues
b) A 72-year-old with severe lung disease
c) A 55-year-old with severe COPD and no major health conditions
d) A 40-year-old with non-repairable lung damage
B
300
Why do patients experience increased appetite and potential weight gain after quitting smoking, and what lifestyle changes can help manage this?
Nicotine suppresses appetite and increases metabolism. After quitting, appetite increases, and metabolism slows slightly, leading to potential weight gain. To manage this, patients should eat high-fiber foods (fruits, vegetables) to maintain energy levels and feel full longer, and engage in regular exercise to balance metabolism and reduce stress-related eating.
300
Using spirometry, how would you be able to differentiate between asthma and COPD? (give specific numbers).
COPD is not fully reversible with bronchodilators (less than 12% increase in either FVC or FEV1 or less than 200mL).
300
Which of the following is correct with regards to the use of a sputum culture?
A. It is a great diagnostic tool for viral infections.
B. It is more commonly used for asthma patients than COPD patients.
C. It is a better test to use for bacterial infections, when compared to a nasal swab.
D. It is the gold standard test for Group A Streptococcus infections.
C.
400
Why do none of the current pharmacological treatments for COPD modify the progressive decline in lung function?
COPD is characterized by irreversible airflow limitation due to structural lung changes. Current medications manage symptoms and exacerbations but do not reverse lung damage or alter disease progression.
400
What is a major drawback of lung volume reduction surgery (LVRS)? (Multiselect)
a) It is not effective for patients with small scattered bullae
b) It removes some healthy air sacs along with the damaged ones
c) It requires the patient to be under 50 years old
d) It is only beneficial for those with mild emphysema
A and B
400
Explain how exercise benefits COPD patients beyond improving cardiovascular fitness.
Regular moderate-intensity exercise (at least 30 minutes most days of the week) not only improves cardiovascular health but also:
Reduces stress (helping with smoking cessation)
Boosts mood (reducing anxiety and depression)
Enhances lung function efficiency (reducing breathlessness)
Increases energy levels (preventing post-smoking fatigue)
Prevents weight gain (helping manage metabolism changes after quitting smoking).
400
Outline the steps of how a DLCO test is done on a patient.
Patient inhales a gas mixture containing: 0.3% CO (binds to Hb like oxygen), tracer gas (e.g. He) which helps measure lung volume, Oxygen and nitrogen (mixture)
Gas exchange occurs in alveoli- CO moves across alveolar membrane into pulmonary capillaries
Exhalation + measurement- patient exhales and machine measures how much CO was absorbed (not exhaled back out), how much tracer gas remains (to estimate lung volume)
Calculations: inhaled - exhaled CO = how efficiently CO diffused into blood
400
What are 3 common CXR presentations of a COPD patient?
Lung hyperinflation.
Diaphragmatic flattening.
Air-filled cystic spaces (bullae).
500
What is the role of oral corticosteroids in COPD management, and how do they differ from inhaled corticosteroids (ICS) in their use?
Oral corticosteroids (e.g., prednisone) are used for short courses (3–5 days) during exacerbations to improve lung function and symptoms. Inhaled corticosteroids (e.g., fluticasone, budesonide) are for long-term maintenance in severe COPD with frequent exacerbations but are less effective due to glucocorticoid resistance.
500
Compare and contrast bullectomy and endobronchial valve volume removal in terms of their approach and level of invasiveness.
500
Describe the "4 D’s" strategy for managing smoking cravings and explain why each step is effective in behavioral modification.
The "4 D’s" help break smoking habits by addressing physiological and psychological cravings:
Delay (Wait 10 minutes): Urges typically pass within a few minutes. This disrupts impulsive smoking behaviour.
Deep Breathing (Take slow, deep breaths): Activates the parasympathetic nervous system, reducing stress and calming cravings.
Drink Water (Keeps hands and mouth busy): Replaces the oral fixation of smoking while promoting hydration.
Do Something Else (Distracts from cravings): Engages the brain in another activity, shifting focus away from smoking cues.
500
In DLCO, what is the normal percentage range of predicted value? (approx. range)
DLCO value between 75% to 140% of the predicted value is considered normal.
500
What are 2 subtle signs that may appear in the CXR of a patient with severe asthma?
Mucous plugging in the airways.
Peribronchial thickness.