Chronic obstructive pulmonary disease: management principles MCQs With Answer

Introduction

This quiz set on “Chronic obstructive pulmonary disease: management principles” is designed for M.Pharm students preparing for Pharmacotherapeutics I (MPP 102T). It focuses on pharmacologic and non‑pharmacologic management strategies, mechanisms of action, indications, adverse effects, guideline‑based therapy decisions (including GOLD recommendations), exacerbation management and drug interactions relevant to COPD. Questions emphasize clinical reasoning, drug selection, and monitoring principles required for advanced pharmaceutical practice and rational therapeutics. Use these MCQs to test and consolidate knowledge of bronchodilators, inhaled corticosteroids, PDE4 inhibitors, theophylline, antibiotics, long‑term oxygen therapy, and supportive care measures in COPD management.

Q1. Which best describes the mechanism of action of tiotropium in COPD management?

• Short‑acting β2‑agonist that stimulates bronchodilation through cAMP
• Long‑acting muscarinic antagonist causing bronchodilation by blocking M3 receptors
• Inhaled corticosteroid that reduces airway eosinophilia and inflammation
• Phosphodiesterase‑4 inhibitor that increases intracellular cAMP in inflammatory cells

Correct Answer: Long‑acting muscarinic antagonist causing bronchodilation by blocking M3 receptors

Q2. According to GOLD recommendations, the preferred initial pharmacotherapy for a symptomatic COPD patient with low exacerbation risk (Group B) is:

• Short‑acting bronchodilator only as needed
• Inhaled corticosteroid monotherapy
• Long‑acting bronchodilator (LAMA or LABA)
• Oral theophylline maintenance therapy

Correct Answer: Long‑acting bronchodilator (LAMA or LABA)

Q3. Inhaled corticosteroids (ICS) are primarily indicated in COPD for patients who:

• Have mild symptoms and no exacerbations
• Have frequent exacerbations despite optimized bronchodilator therapy and elevated blood eosinophils
• Require rescue therapy for acute bronchospasm
• Have isolated emphysema without chronic bronchitis

Correct Answer: Have frequent exacerbations despite optimized bronchodilator therapy and elevated blood eosinophils

Q4. Roflumilast is best described as which of the following and is indicated for which COPD phenotype?

• Macrolide antibiotic indicated for chronic productive cough
• PDE4 inhibitor indicated for severe COPD with chronic bronchitis and frequent exacerbations
• Bronchodilator indicated as first‑line monotherapy in Group A patients
• Inhaled anticholinergic indicated for acute exacerbations

Correct Answer: PDE4 inhibitor indicated for severe COPD with chronic bronchitis and frequent exacerbations

Q5. What is the most common adverse effect associated with inhaled antimuscarinic agents (e.g., tiotropium)?

• Oral candidiasis
• Systemic corticosteroid‑like Cushingoid features
• Dry mouth
• QT prolongation

Correct Answer: Dry mouth

Q6. Long‑term oxygen therapy (LTOT) is indicated to reduce mortality in COPD patients who have:

• Transient nocturnal desaturation only
• Mild hypoxemia with PaO2 65–70 mmHg at rest
• Resting PaO2 ≤55 mmHg or SaO2 ≤88% on room air
• Exercise‑induced desaturation that resolves with activity cessation

Correct Answer: Resting PaO2 ≤55 mmHg or SaO2 ≤88% on room air

Q7. First‑line management of an acute COPD exacerbation in the outpatient setting typically includes:

• Immediate initiation of inhaled corticosteroid monotherapy
• Inhaled short‑acting bronchodilators, short course systemic corticosteroids, and antibiotics if bacterial infection suspected
• Daily roflumilast and long‑term macrolide prophylaxis
• Chronic theophylline dose escalation

Correct Answer: Inhaled short‑acting bronchodilators, short course systemic corticosteroids, and antibiotics if bacterial infection suspected

Q8. Theophylline produces bronchodilation primarily through which mechanisms?

• Selective β2 agonism with no central nervous system effects
• Nonselective phosphodiesterase inhibition and antagonism of adenosine receptors
• Muscarinic receptor blockade at M3 receptors
• Mediating anti‑TNF effects to reduce inflammation

Correct Answer: Nonselective phosphodiesterase inhibition and antagonism of adenosine receptors

Q9. Which drug interaction is most likely to increase plasma theophylline concentrations and toxicity risk?

• Chronic cigarette smoking
• Carbamazepine coadministration
• Ciprofloxacin coadministration
• High‑dose oral vitamin C

Correct Answer: Ciprofloxacin coadministration

Q10. Which vaccination is recommended annually for patients with COPD to reduce exacerbation risk and disease complications?

• Pneumococcal conjugate vaccine every year
• Influenza vaccination annually
• BCG vaccination annually
• Varicella vaccination annually

Correct Answer: Influenza vaccination annually

Q11. For immediate relief of acute breathlessness in COPD, the preferred rescue medication is:

• Long‑acting muscarinic antagonist (tiotropium)
• Short‑acting β2‑agonist (salbutamol/albuterol)
• Oral corticosteroids daily
• Roflumilast

Correct Answer: Short‑acting β2‑agonist (salbutamol/albuterol)

Q12. Triple inhaled therapy (LABA + LAMA + ICS) is recommended when:

• Patients have no symptoms and no exacerbations
• Patients have persistent exacerbations despite dual bronchodilator therapy or have high eosinophil counts and exacerbations
• Used as initial therapy in all newly diagnosed COPD patients
• Only used for acute rescue treatment

Correct Answer: Patients have persistent exacerbations despite dual bronchodilator therapy or have high eosinophil counts and exacerbations

Q13. Which oral antibiotic is commonly recommended for outpatient treatment of a suspected bacterial COPD exacerbation?

• Amoxicillin‑clavulanic acid
• Vancomycin
• Linezolid
• Ciprofloxacin intravenous only

Correct Answer: Amoxicillin‑clavulanic acid

Q14. Which bronchodilator is an ultra‑long‑acting β2‑agonist typically administered once daily?

• Salmeterol
• Formoterol
• Indacaterol
• Salbutamol

Correct Answer: Indacaterol

Q15. A common acute adverse effect of systemic corticosteroid therapy used during COPD exacerbations is:

• Weight loss and diarrhea
• Hyperglycemia
• Acute renal failure
• Severe bradycardia

Correct Answer: Hyperglycemia

Q16. Which COPD intervention has been shown to reduce long‑term mortality in selected patients?

• Routine inhaled corticosteroid monotherapy for all patients
• Long‑term oxygen therapy in patients with severe resting hypoxemia
• Daily mucolytics for all COPD phenotypes
• Short‑acting bronchodilator use only as needed

Correct Answer: Long‑term oxygen therapy in patients with severe resting hypoxemia

Q17. The most frequent adverse effects observed with roflumilast therapy are:

• Hypertension and hyperkalemia
• Diarrhea and weight loss
• Ototoxicity and tinnitus
• Bronchospasm and immediate hypersensitivity

Correct Answer: Diarrhea and weight loss

Q18. Long‑term prophylactic azithromycin is considered for COPD patients who:

• Have never had an exacerbation
• Have frequent exacerbations despite optimal inhaled therapy and no contraindications to macrolides
• Are smokers who quit less than one month ago
• Are currently on long‑term systemic corticosteroids only

Correct Answer: Have frequent exacerbations despite optimal inhaled therapy and no contraindications to macrolides

Q19. Using a spacer with a pressurized metered‑dose inhaler (pMDI) in COPD patients primarily:

• Increases systemic absorption of inhaled corticosteroids
• Reduces oropharyngeal deposition and improves drug delivery to the lungs
• Is only necessary for nebulizer treatments
• Eliminates the need for inhaled bronchodilators

Correct Answer: Reduces oropharyngeal deposition and improves drug delivery to the lungs

Q20. Which mucolytic agent is used in COPD to help reduce sputum viscosity and can decrease exacerbation frequency in chronic bronchitic phenotypes?

• N‑acetylcysteine
• Roflumilast
• Tiotropium
• Salbutamol

Correct Answer: N‑acetylcysteine

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