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Chapter 15. Chronic Obstructive Pulmonary Disease

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All of the following play a role in the pathophysiology of COPD except:

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A. Chronic inflammation from repeated exposure to noxious particles and gases

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B. An imbalance between proteinases and antiproteinases

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C. Inflammation similar to what is seen in asthma, which is mainly mediated through eosinophils and mast cells

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D. Oxidative stress

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E. Impairment of the normal protective and repair mechanisms in the lungs

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In COPD, where in the lungs is the primary site of obstruction?

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A. Large bronchi

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B. Large bronchioles

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C. Mucus glands

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D. Small bronchi and bronchioles

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E. Trachea

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A 67-year-old man presents to his primary care physician complaining of productive cough and dyspnea on exertion for the past 6 months; COPD is suspected. Which of the following further supports the diagnosis of COPD?

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A. A 45 pack–year history of smoking

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B. FEV1/FVC of 60% (0.60)

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C. Family history of AAT deficiency

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D. Fifteen years of employment in a plastics plant with exposure to talc

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E. All of the above

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Which of the following is an adverse effect of tiotropium?

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A. Hypokalemia

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B. Dry mouth

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C. Insomnia

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D. Irritability

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E. Seizures

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A 66-year-old man was admitted to the hospital 4 days ago for an acute COPD exacerbation. During this hospitalization, he has been treated with albuterol 2.5 mg via nebulizer every 4 hours, ipratropium 0.5 mg via nebulizer every 8 hours, prednisone 30 mg orally once daily, and cefuroxime axetil 500 mg orally twice daily, as well as fluticasone 110 mcg inhaled twice daily and theophylline 200 mg orally twice daily (fluticasone and theophylline were continued from outpatient treatment). Today he complains of restlessness and feeling like his heart is racing, which he attributes to being unable to smoke since being admitted to the hospital. Which of the following is/are alternative causes of these symptoms?

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A. Theophylline toxicity secondary ...

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