Obstructive Airway Diseases (Asthma, COPD) — MCQs
Which of the following medications should be avoided in a patient with asthma?
A 68-year-old male presents with cough, sputum production, bronchial breath sounds, respiratory rate of 20/min, urea of 44 mg/dl, and BP of 110/70 mmHg. What is the next step in management?
A 35-year-old woman with a long history of dyspnea, chronic cough, sputum production, and wheezing dies of respiratory failure following a bout of lobar pneumonia. She was not a smoker or an alcoholic. Which of the following underlying conditions is most likely associated with the pathologic changes shown in the lung autopsy?
What is the most common cause of Chronic Obstructive Pulmonary Disease (COPD)?
A 60-year-old male with COPD has FEV1 45% predicted, mMRC grade 2 dyspnea, and 2 exacerbations last year. Which GOLD category?
A 57-year-old man presents to the clinic with shortness of breath on exertion, which started several months after a cold and has been worsening. He reports no cough or sputum production, a 40-pack-per-year history of smoking, and a past history of well-controlled hypertension on amlodipine. On physical examination, he has bilateral wheezes on expiration and increased resonance to percussion of the chest. Pulmonary function tests confirm the diagnosis of chronic obstructive lung disease (COPD). Which of the following best describes the condition of COPD?
Which of the following statements is true regarding the diagnostic criteria for Chronic Obstructive Pulmonary Disease (COPD)?
A person experiences asthma attacks more than twice during the day and at least once during the night. What is the most likely classification of their asthma?
What does a decreased FEV1/FVC ratio typically indicate in pulmonary function tests?
What is the term for the collapse of a lung?
Obstructive Airway Diseases (Asthma, COPD) Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following medications should be avoided in a patient with asthma?
- A. theophylline
- B. corticosteroids
- C. sympathomimetic amines
- D. beta-blockers (Correct Answer)
Explanation: ***Correct Answer: beta-blockers*** - **Non-selective beta-blockers** can block beta-2 adrenergic receptors in the lungs, leading to **bronchoconstriction** and worsening asthma symptoms. - Even **cardioselective beta-blockers** (beta-1 selective) should be used with caution as their selectivity can be lost at higher doses. - Beta-blockers are **contraindicated** in asthma patients due to risk of severe bronchospasm. *Incorrect: theophylline* - **Theophylline** is a bronchodilator used in asthma management, particularly for **nocturnal symptoms** or as add-on therapy. - It works by inhibiting phosphodiesterase, increasing intracellular cAMP, which leads to **smooth muscle relaxation**. *Incorrect: corticosteroids* - **Corticosteroids** (inhaled or systemic) are a cornerstone in asthma management due to their potent **anti-inflammatory effects**. - They reduce airway inflammation, reduce **bronchial hyperresponsiveness**, and decrease the frequency and severity of asthma exacerbations. *Incorrect: sympathomimetic amines* - Many **sympathomimetic amines**, such as **beta-2 agonists** (e.g., albuterol, salmeterol), are primary bronchodilators used in asthma. - They work by stimulating beta-2 adrenergic receptors in the airway smooth muscle, leading to **bronchodilation**.
Question 2: A 68-year-old male presents with cough, sputum production, bronchial breath sounds, respiratory rate of 20/min, urea of 44 mg/dl, and BP of 110/70 mmHg. What is the next step in management?
- A. Admit in ICU without mechanical ventilation (MV)
- B. Home treatment (Rx)
- C. Admit in ICU with mechanical ventilation (MV)
- D. Room admission (Correct Answer)
- E. Observation in emergency department
Explanation: ***Room admission*** - The patient's **CURB-65 score** is **2** (one point for urea >7 mmol/L [44 mg/dL = 15.7 mmol/L] and one point for age ≥65 years), indicating **moderate mortality risk** and clear need for **hospital admission**. - **CURB-65 score of 2** mandates inpatient admission for monitoring, IV antibiotics if needed, and supportive care in a general medical ward. - While showing signs of respiratory infection, the vital signs are stable and do not meet criteria for ICU admission. *Admit in ICU without mechanical ventilation (MV)* - **ICU criteria** for pneumonia typically include severe respiratory failure, hemodynamic instability (shock requiring vasopressors), or impending organ dysfunction, which are not met. - The patient's respiratory rate (20/min) and blood pressure (110/70 mmHg) are within acceptable limits for a non-ICU setting. - CURB-65 score of 3-5 or presence of major severity criteria would warrant ICU consideration. *Home treatment (Rx)* - **CURB-65 score of 2** precludes outpatient management and requires hospital admission. - Outpatient treatment is only appropriate for CURB-65 scores of 0-1 in patients without other comorbidities. - Given the patient's age (68 years), elevated urea, and presence of **bronchial breath sounds** consistent with consolidative pneumonia, **hospital admission** is mandatory. *Admit in ICU with mechanical ventilation (MV)* - There is no indication of **severe respiratory distress** (e.g., severe hypoxemia with SpO2 <90% on high-flow oxygen, hypercapnia, or respiratory acidosis) that would necessitate immediate mechanical ventilation. - The respiratory rate of 20/min is normal, and there is no mention of altered mental status, severe tachypnea, or increased work of breathing. *Observation in emergency department* - While brief observation may be appropriate for borderline cases, a **CURB-65 score of 2** indicates the patient requires formal hospital admission rather than just ED observation. - The presence of consolidation (bronchial breath sounds) and elevated urea support the need for inpatient ward admission with monitoring and treatment.
Question 3: A 35-year-old woman with a long history of dyspnea, chronic cough, sputum production, and wheezing dies of respiratory failure following a bout of lobar pneumonia. She was not a smoker or an alcoholic. Which of the following underlying conditions is most likely associated with the pathologic changes shown in the lung autopsy?
- A. Antibodies against type 4 collagen (associated with Goodpasture syndrome)
- B. Cystic fibrosis (a genetic disorder affecting the lungs)
- C. Mutation in dynein arms (associated with primary ciliary dyskinesia)
- D. Alpha-1 antitrypsin deficiency (Correct Answer)
Explanation: ***Alpha 1 antitrypsin deficiency*** - This condition leads to **accumulation of abnormal protein** in the liver and lungs, resulting in emphysema, which is consistent with chronic cough and dyspnea [1]. - Patients often develop **lung pathology** similar to what is seen in smokers, making it plausible given the patient's background [1]. *Mutation in dynein arms* - This is associated with **primary ciliary dyskinesia**, which presents with recurrent respiratory infections but is not typical in non-smokers or in the context of **dyspnea with chronic cough**. - Usually linked to **situs inversus** and **recurrent infections**, neither of which is highlighted here. *Antibodies against type 4 collagen* - This condition is related to **Goodpasture syndrome**, which typically results in **hemoptysis** and **renal failure**, rather than chronic cough and sputum production. - The predominant involvement in this syndrome does not align with the clinical presentation of **chronic lung disease** noted in this patient. *Cystic fibrosis* - While it causes **chronic respiratory symptoms**, it is usually seen in younger patients and is associated with **pancreatic insufficiency** and **salty sweat**. - The age of the patient and symptom progression does not fit well with a diagnosis of cystic fibrosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 683-684.
Question 4: What is the most common cause of Chronic Obstructive Pulmonary Disease (COPD)?
- A. Smoking (Correct Answer)
- B. Exposure to air pollutants
- C. Genetic predisposition
- D. Occupational exposure
Explanation: ***Smoking*** - **Smoking** is by far the leading cause of COPD, accounting for approximately 80-90% of all cases [1]. - inhaling **toxic chemicals** and irritants in tobacco smoke causes chronic inflammation and damage to the airways and alveoli [1]. *Exposure to air pollutants* - Chronic exposure to indoor and outdoor **air pollutants**, such as biomass fuel smoke or industrial emissions, can contribute to COPD. - However, their impact is generally **less significant** than that of active smoking in the general population [1]. *Genetic predisposition* - A rare genetic condition, **alpha-1 antitrypsin deficiency**, can lead to early-onset COPD, especially in non-smokers. - While other **genetic factors** may influence susceptibility, they do not represent the most common cause [1]. *Occupational exposure* - Prolonged exposure to certain **occupational dusts** and chemicals, such as cadmium, silica, and cotton dust, can cause COPD. - This is a significant risk factor for specific populations but is **not the most common cause** overall.
Question 5: A 60-year-old male with COPD has FEV1 45% predicted, mMRC grade 2 dyspnea, and 2 exacerbations last year. Which GOLD category?
- A. GOLD A
- B. GOLD D (Correct Answer)
- C. GOLD B
- D. GOLD C
Explanation: Gold D - This patient meets criteria for **GOLD D** due to both high symptom burden (mMRC grade 2 dyspnea) and a high risk of exacerbations (2 exacerbations last year) [1]. - COPD severity in GOLD D is characterized by an **FEV1 < 50% predicted** (in this case, 45%) along with significant symptoms and/or frequent exacerbations [1]. *GOLD A* - **GOLD A** patients have low symptom burden (mMRC 0-1 or CAT < 10) and a low risk of exacerbations (0-1 exacerbations not leading to hospitalization) [1]. - This patient's **mMRC grade 2** and **2 exacerbations** last year exclude him from GOLD A. *GOLD B* - **GOLD B** patients have a high symptom burden (mMRC ≥ 2 or CAT ≥ 10) but a low risk of exacerbations (0-1 exacerbations not leading to hospitalization) [1]. - This patient's **2 exacerbations** last year place him in a higher risk category than GOLD B. *GOLD C* - **GOLD C** patients have a low symptom burden (mMRC 0-1 or CAT < 10) but a high risk of exacerbations (≥ 2 exacerbations or ≥ 1 leading to hospitalization) [1]. - This patient's **mMRC grade 2** indicates a high symptom burden, which is not characteristic of GOLD C.
Question 6: A 57-year-old man presents to the clinic with shortness of breath on exertion, which started several months after a cold and has been worsening. He reports no cough or sputum production, a 40-pack-per-year history of smoking, and a past history of well-controlled hypertension on amlodipine. On physical examination, he has bilateral wheezes on expiration and increased resonance to percussion of the chest. Pulmonary function tests confirm the diagnosis of chronic obstructive lung disease (COPD). Which of the following best describes the condition of COPD?
- A. It is a condition that can include chronic bronchitis and emphysema.
- B. It is airflow limitation that is not fully reversible. (Correct Answer)
- C. It is primarily due to chronic inflammation of the airways.
- D. It is characterized by reversible airway obstruction.
Explanation: ***It is airflow limitation that is not fully reversible.*** - **COPD** is fundamentally defined by **airflow limitation** that is not fully reversible with bronchodilators, differentiating it from conditions like asthma [1]. - This **irreversible airflow obstruction** is typically progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases [1]. *It is a condition that can include chronic bronchitis and emphysema.* - While **chronic bronchitis** and **emphysema** are major components and phenotypes of COPD, this statement describes its constituent parts rather than its overarching definition [2]. - COPD is a broader term encompassing these conditions when they lead to characteristic **non-reversible airflow limitation**. *It is primarily due to chronic inflammation of the airways.* - **Chronic inflammation** is a key pathological feature of COPD, but it is not the defining characteristic or the most accurate description of the condition itself. - This inflammation leads to the structural changes and **airflow limitation** that define COPD [1]. *It is characterized by reversible airway obstruction.* - **Reversible airway obstruction** is the hallmark of diseases like **asthma**, where airway narrowing can be significantly improved with medication [1]. - In contrast, COPD is defined by **irreversible** or only partially reversible airflow limitation.
Question 7: Which of the following statements is true regarding the diagnostic criteria for Chronic Obstructive Pulmonary Disease (COPD)?
- A. A post-bronchodilator FEV1/FVC ratio above the threshold indicates normal lung function.
- B. A post-bronchodilator FEV1/FVC ratio below the threshold indicates airflow limitation. (Correct Answer)
- C. Residual Volume (RV) is normal.
- D. Total Lung Capacity (TLC) is decreased.
Explanation: ***A post-bronchodilator FEV1/FVC ratio below the threshold indicates airflow limitation.*** [1] - This is the **hallmark diagnostic criterion** for COPD, confirming persistent **airflow obstruction** that is not fully reversible. [1] - The threshold typically used is **< 0.70** or below the **fifth percentile** of the lower limit of normal (LLN). *A post-bronchodilator FEV1/FVC ratio above the threshold indicates normal lung function.* - An FEV1/FVC ratio **above the threshold** indicates the absence of significant **airflow obstruction**, but does not automatically guarantee normal lung function as other parameters like **FEV1** could be affected. - This measurement would suggest a **restrictive lung disease** or **normal lung function**, depending on other spirometry values. *Residual Volume (RV) is normal.* - In COPD, **air trapping** due to airflow obstruction leads to an **increased Residual Volume (RV)**, not a normal RV. - An elevated RV reflects **hyperinflation** of the lungs, a characteristic feature of emphysema and chronic bronchitis. *Total Lung Capacity (TLC) is decreased.* - COPD is characterized by **hyperinflation**, which typically results in an **increased Total Lung Capacity (TLC)** as the lungs become more distended. - A **decreased TLC** would be indicative of a **restrictive lung disease**, which is different from obstructive patterns seen in COPD.
Question 8: A person experiences asthma attacks more than twice during the day and at least once during the night. What is the most likely classification of their asthma?
- A. Intermittent asthma
- B. Mild persistent asthma
- C. Moderate persistent asthma
- D. Severe persistent asthma (Correct Answer)
Explanation: ***Severe persistent asthma*** - This classification is characterized by **frequent symptoms**, specifically asthma attacks occurring more than twice daily and at least once nightly. - Individuals with severe persistent asthma often experience significant limitations in their daily activities and may have a **FEV1 (forced expiratory volume in 1 second)** less than 60% of predicted. *Intermittent asthma* - This classification is characterized by symptoms occurring less than two days per week and **nighttime awakenings less than two times per month**. - Symptoms are generally well-controlled with a short-acting beta-agonist (SABA) as needed. *Mild persistent asthma* - Patients with mild persistent asthma typically experience symptoms more than twice a week but **less than once a day**, and **nighttime awakenings 3-4 times per month**. - Their lung function (FEV1) is usually 80% or more of predicted. *Moderate persistent asthma* - This category involves daily symptoms and **nighttime awakenings more than once per week but not nightly**. - Lung function (FEV1) in moderate persistent asthma typically falls between 60% and 80% of predicted.
Question 9: What does a decreased FEV1/FVC ratio typically indicate in pulmonary function tests?
- A. Normal pulmonary function
- B. Obstructive lung disease (Correct Answer)
- C. Restrictive lung disease
- D. Both obstructive and restrictive lung disease
Explanation: ***Obstructive lung disease*** - A decreased **FEV1/FVC ratio** indicates that the amount of air forcefully exhaled in one second (FEV1) is disproportionately low compared to the total forced vital capacity (FVC) [1]. This is a hallmark of **airflow limitation**, distinguishing obstructive lung diseases. - This pattern suggests a problem with **airway narrowing** or obstruction, making it difficult to exhale air quickly, which is characteristic of conditions like **COPD** (emphysema, chronic bronchitis) or **asthma** [1]. *Normal pulmonary function* - In normal pulmonary function, the **FEV1/FVC ratio** would be within the expected reference range, typically **above 70%** (or 0.7) for adults [1]. - A low ratio explicitly indicates a deviation from normal airflow dynamics, not a state of healthy lung function. *Restrictive lung disease* - **Restrictive lung diseases** are characterized by a **reduced total lung volume** (decreased FVC), but the FEV1/FVC ratio is typically **normal or even increased**. - This is because the airways are generally not obstructed; instead, the problem lies with the lungs' inability to expand fully, leading to a proportional reduction in FEV1 and FVC. *Both obstructive and restrictive lung disease* - While it is possible to have both conditions, a **decreased FEV1/FVC ratio** primarily points to an **obstructive pattern**. - A definitive diagnosis of both would require further interpretation of other PFT parameters such as **total lung capacity (TLC)**, which would be normal or increased in obstruction and reduced in restriction.
Question 10: What is the term for the collapse of a lung?
- A. Emphysema
- B. Atelectasis (Correct Answer)
- C. Bronchitis
- D. Bronchiectasis
Explanation: ***Atelectasis*** - **Atelectasis** is the technical term for the **collapse of a lung** or a part of a lung, leading to reduced or absent gas exchange. - It can be caused by **obstruction of the airway** (e.g., mucus plug, foreign body) or external compression on the lung [1]. *Emphysema* - **Emphysema** is a chronic lung disease characterized by the **destruction of the alveoli**, leading to permanent enlargement of airspaces [2]. - It results in reduced elastic recoil of the lungs and is a type of **COPD (chronic obstructive pulmonary disease)** [2]. *Bronchiectasis* - **Bronchiectasis** is a chronic condition where the airways (bronchi) become **abnormally widened** and scarred. - This widening leads to a buildup of mucus, making the lungs vulnerable to **recurrent infections**. *Bronchitis* - **Bronchitis** is an inflammation of the lining of the bronchial tubes, which carry air to and from your lungs. - It typically causes a **cough** with mucus production and can be acute or chronic.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free