MCQ Quiz: Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable, and treatable disease characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities, usually caused by significant exposure to noxious particles or gases. Its management requires a comprehensive approach aimed at reducing symptoms, improving exercise tolerance and health status, and preventing and treating exacerbations. For PharmD students, a thorough understanding of COPD pathophysiology, assessment using tools like the GOLD classification, and the full spectrum of pharmacological and non-pharmacological management strategies is essential for optimizing patient care and reducing the burden of this chronic illness. This MCQ quiz will test your knowledge on the key aspects of COPD.

1. COPD is characterized by airflow limitation that is:

• A. Fully reversible with bronchodilators.
• B. Not fully reversible and usually progressive.
• C. Only present during sleep.
• D. Caused by acute allergic inflammation.

Answer: B. Not fully reversible and usually progressive.

2. The diagnosis of COPD requires post-bronchodilator spirometry showing which of the following results?

• A. FEV1/FVC ratio > 0.70
• B. FEV1/FVC ratio < 0.70
• C. FVC > 80% predicted
• D. FEV1 > 80% predicted

Answer: B. FEV1/FVC ratio < 0.70

3. The two main pathological components of COPD are chronic bronchitis and:

• A. Asthma
• B. Emphysema (destruction of gas-exchanging surfaces of the lung)
• C. Pulmonary fibrosis
• D. Pneumonia

Answer: B. Emphysema (destruction of gas-exchanging surfaces of the lung)

4. The single most important risk factor for the development of COPD is:

• A. Genetic predisposition
• B. Occupational dust exposure
• C. Tobacco smoking
• D. Childhood respiratory infections

Answer: C. Tobacco smoking

5. The pathophysiology of COPD is characterized by chronic inflammation predominantly involving which cell types?

• A. Eosinophils and Th2 lymphocytes
• B. Mast cells and basophils
• C. Neutrophils, macrophages, and CD8+ T-lymphocytes
• D. Natural killer (NK) cells

Answer: C. Neutrophils, macrophages, and CD8+ T-lymphocytes

6. A genetic deficiency of which protein can lead to early-onset emphysema?

• A. Alpha-1 antitrypsin (AAT)
• B. Surfactant protein B
• C. Immunoglobulin E (IgE)
• D. Myeloperoxidase

Answer: A. Alpha-1 antitrypsin (AAT)

7. The cornerstone of pharmacological therapy for COPD for symptom relief is:

• A. Inhaled corticosteroids
• B. Bronchodilators (e.g., beta2-agonists and muscarinic antagonists)
• C. Leukotriene receptor antagonists
• D. Oral corticosteroids

Answer: B. Bronchodilators (e.g., beta2-agonists and muscarinic antagonists)

8. According to the updated GOLD guidelines (2023 and beyond), patients with COPD are classified into which assessment groups to guide initial therapy?

• A. Groups A, B, C, D
• B. Groups A, B, E
• C. Stages I, II, III, IV
• D. Mild, Moderate, Severe, Very Severe

Answer: B. Groups A, B, E

9. For initial pharmacological management of a patient in GOLD Group B (more symptomatic, low exacerbation risk), guidelines typically recommend:

• A. A short-acting bronchodilator as needed.
• B. An inhaled corticosteroid (ICS) monotherapy.
• C. A combination LAMA + LABA dual bronchodilator therapy.
• D. Roflumilast.

Answer: C. A combination LAMA + LABA dual bronchodilator therapy.

10. For initial pharmacological management of a patient in GOLD Group E (experiencing frequent exacerbations), guidelines typically recommend:

• A. A short-acting bronchodilator as needed.
• B. A LAMA + LABA combination, with consideration for adding an ICS if blood eosinophils are high (e.g., ≥300 cells/µL).
• C. LABA monotherapy.
• D. SABA monotherapy.

Answer: B. A LAMA + LABA combination, with consideration for adding an ICS if blood eosinophils are high (e.g., ≥300 cells/µL).

11. Long-acting muscarinic antagonists (LAMAs) like tiotropium cause bronchodilation by blocking:

• A. Beta-2 adrenergic receptors
• B. M3 muscarinic receptors on airway smooth muscle
• C. Leukotriene receptors
• D. Phosphodiesterase-4

Answer: B. M3 muscarinic receptors on airway smooth muscle

12. Inhaled corticosteroid (ICS) monotherapy is generally NOT recommended for the long-term treatment of COPD because:

• A. It has no effect on inflammation in COPD.
• B. It has less favorable risk-benefit profile compared to long-acting bronchodilators and is associated with an increased risk of pneumonia without a clear mortality benefit as monotherapy.
• C. It is more expensive than all other options.
• D. It causes severe bronchoconstriction.

Answer: B. It has less favorable risk-benefit profile compared to long-acting bronchodilators and is associated with an increased risk of pneumonia without a clear mortality benefit as monotherapy.

13. Which of the following is the single most effective (and cost-effective) intervention to reduce the risk of developing COPD and slow its progression?

• A. Daily use of a SABA
• B. Annual influenza vaccination
• C. Smoking cessation
• D. Long-term oxygen therapy

Answer: C. Smoking cessation

14. The assessment of COPD symptom burden can be done using standardized questionnaires such as the CAT (COPD Assessment Test) or the:

• A. Asthma Control Test (ACT)
• B. NYHA Functional Classification
• C. modified Medical Research Council (mMRC) dyspnea scale
• D. TIMI risk score

Answer: C. modified Medical research Council (mMRC) dyspnea scale

15. A COPD exacerbation is defined as an acute worsening of respiratory symptoms that:

• A. Always resolves spontaneously without treatment.
• B. Is always caused by bacterial infections.
• C. Results in the need for additional therapy.
• D. Requires immediate initiation of long-term oxygen therapy.

Answer: C. Results in the need for additional therapy.

16. The cornerstone of management for an acute COPD exacerbation includes:

• A. Increasing the dose of long-acting bronchodilators only.
• B. Initiating inhaled short-acting bronchodilators (SABA +/- SAMA), systemic corticosteroids, and antibiotics if indicated.
• C. Starting long-term oxygen therapy.
• D. Administering prophylactic theophylline.

Answer: B. Initiating inhaled short-acting bronchodilators (SABA +/- SAMA), systemic corticosteroids, and antibiotics if indicated.

17. Antibiotics are generally recommended for COPD exacerbations in patients who have:

• A. Mild symptoms of increased dyspnea only.
• B. All three cardinal symptoms (increased dyspnea, increased sputum volume, increased sputum purulence) or two cardinal symptoms if one is increased purulence.
• C. A viral cause identified.
• D. Been hospitalized within the last year.

Answer: B. All three cardinal symptoms (increased dyspnea, increased sputum volume, increased sputum purulence) or two cardinal symptoms if one is increased purulence.

18. Roflumilast, a phosphodiesterase-4 (PDE4) inhibitor, is indicated for reducing exacerbations in patients with:

• A. Mild COPD (GOLD Group A)
• B. Severe COPD with chronic bronchitis and a history of frequent exacerbations
• C. Asthma-COPD overlap
• D. Alpha-1 antitrypsin deficiency

Answer: B. Severe COPD with chronic bronchitis and a history of frequent exacerbations

19. Long-term oxygen therapy is indicated for stable COPD patients with:

• A. Mild dyspnea on exertion.
• B. Chronic severe resting hypoxemia (e.g., PaO2 ≤ 55 mmHg or SaO2 ≤ 88%).
• C. Any level of FEV1 impairment.
• D. Frequent exacerbations but normal oxygen saturation.

Answer: B. Chronic severe resting hypoxemia (e.g., PaO2 ≤ 55 mmHg or SaO2 ≤ 88%).

20. Pulmonary rehabilitation is a comprehensive, multidisciplinary intervention for symptomatic COPD patients that has been shown to:

• A. Reverse all pathological lung damage.
• B. Have no significant benefit.
• C. Improve exercise capacity, reduce symptoms of dyspnea, and improve quality of life.
• D. Increase the risk of COPD exacerbations.

Answer: C. Improve exercise capacity, reduce symptoms of dyspnea, and improve quality of life.

21. A key difference in the pharmacological management of COPD compared to asthma is that:

• A. Inhaled corticosteroids are first-line monotherapy for COPD.
• B. Long-acting bronchodilators (LAMAs and LABAs) are central to COPD management, and LABA monotherapy is an acceptable option.
• C. Short-acting bronchodilators are not used in COPD.
• D. Leukotriene modifiers are highly effective in COPD.

Answer: B. Long-acting bronchodilators (LAMAs and LAMAs) are central to COPD management, and LABA monotherapy is an acceptable option.

22. Which of the following vaccinations are recommended for nearly all patients with COPD?

• A. Only the measles, mumps, and rubella (MMR) vaccine
• B. Influenza (annually) and pneumococcal vaccines
• C. Only the tetanus vaccine
• D. The yellow fever vaccine

Answer: B. Influenza (annually) and pneumococcal vaccines

23. Chronic hypoxemia in COPD can lead to which long-term cardiovascular complication?

• A. Systemic hypertension
• B. Pulmonary hypertension and cor pulmonale (right-sided heart failure)
• C. Aortic stenosis
• D. Atrial fibrillation only

Answer: B. Pulmonary hypertension and cor pulmonale (right-sided heart failure)

24. The term “chronic bronchitis” is clinically defined by:

• A. The presence of emphysema on a chest CT scan.
• B. A chronic productive cough for 3 months in each of 2 successive years.
• C. A reversible airflow limitation on spirometry.
• D. A positive allergen skin test.

Answer: B. A chronic productive cough for 3 months in each of 2 successive years.

25. Emphysema is pathologically defined by:

• A. Inflammation of the large airways.
• B. Permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls.
• C. Reversible bronchospasm.
• D. Thickening of the bronchial basement membrane.

Answer: B. Permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls.

26. A patient with COPD and a blood eosinophil count >300 cells/µL is more likely to benefit from the addition of which medication to their LAMA/LABA therapy to reduce exacerbations?

• A. A SABA
• B. Roflumilast
• C. An Inhaled Corticosteroid (ICS)
• D. N-acetylcysteine

Answer: C. An Inhaled Corticosteroid (ICS)

27. What is a common side effect of long-acting muscarinic antagonists (LAMAs) like tiotropium?

• A. Diarrhea
• B. Tachycardia
• C. Dry mouth
• D. Sedation

Answer: C. Dry mouth

28. Combination LAMA/LABA inhalers are a cornerstone of therapy for many symptomatic COPD patients because they:

• A. Primarily target airway inflammation.
• B. Provide synergistic bronchodilation by acting on two different mechanisms (cholinergic and adrenergic pathways).
• C. Are less effective than either agent alone.
• D. Eliminate the risk of pneumonia.

Answer: B. Provide synergistic bronchodilation by acting on two different mechanisms (cholinergic and adrenergic pathways).

29. For a COPD patient who continues to have exacerbations on LAMA/LABA therapy, and has a blood eosinophil count of 150 cells/µL, an appropriate next step according to GOLD guidelines could be:

• A. Adding an ICS to make triple therapy (LAMA/LABA/ICS).
• B. Adding roflumilast (if FEV1 <50% and chronic bronchitis phenotype).
• C. Adding a macrolide like azithromycin (if a former smoker).
• D. Any of the above could be considered based on the full patient profile.

Answer: D. Any of the above could be considered based on the full patient profile. (Adding ICS is reasonable at this eosinophil level, and roflumilast/azithromycin are also options based on specific phenotypes).

30. The primary role of short-acting beta2-agonists (SABAs) in the chronic management of COPD is:

• A. As scheduled daily maintenance therapy.
• B. For as-needed relief of acute breakthrough symptoms (dyspnea).
• C. To reduce airway inflammation.
• D. To prevent long-term decline in lung function.

Answer: B. For as-needed relief of acute breakthrough symptoms (dyspnea).

31. Patient education on correct inhaler technique is critical in COPD management because:

• A. Most patients naturally know how to use inhalers correctly.
• B. Incorrect technique can lead to poor drug delivery to the lungs and suboptimal therapeutic effect.
• C. It is only necessary for corticosteroid inhalers.
• D. All inhaler devices are used in the exact same way.

Answer: B. Incorrect technique can lead to poor drug delivery to the lungs and suboptimal therapeutic effect.

32. The pathophysiology of alpha-1 antitrypsin (AAT) deficiency involves:

• A. Excessive activity of AAT, leading to lung inflammation.
• B. Insufficient levels of AAT, a protease inhibitor, leading to unchecked destruction of lung elastin by neutrophil elastase.
• C. An autoimmune reaction against lung tissue.
• D. Severe bronchospasm due to IgE-mediated reactions.

Answer: B. Insufficient levels of AAT, a protease inhibitor, leading to unchecked destruction of lung elastin by neutrophil elastase.

33. Which of the following is a common comorbidity associated with COPD?

• A. Cardiovascular disease, osteoporosis, anxiety/depression, and lung cancer
• B. Type 1 diabetes
• C. Inflammatory bowel disease
• D. Allergic rhinitis

Answer: A. Cardiovascular disease, osteoporosis, anxiety/depression, and lung cancer

34. A “barrel chest” appearance in some patients with severe COPD is due to:

• A. Hypertrophy of the chest wall muscles.
• B. Chronic air trapping and lung hyperinflation.
• C. Fluid accumulation in the pleural space.
• D. Spinal curvature.

Answer: B. Chronic air trapping and lung hyperinflation.

35. A typical course of systemic corticosteroids for a moderate-to-severe COPD exacerbation is:

• A. A single high-dose intravenous injection.
• B. Long-term, indefinite daily oral therapy.
• C. A short course, for example, prednisone 40 mg daily for 5-7 days.
• D. Inhaled corticosteroids at a very high dose.

Answer: C. A short course, for example, prednisone 40 mg daily for 5-7 days.

36. A key difference in the response to therapy between asthma and COPD is that:

• A. Bronchodilator response is typically minimal or absent in asthma.
• B. Airflow limitation in asthma is largely reversible, while in COPD it is not fully reversible.
• C. Inhaled corticosteroids are ineffective in asthma.
• D. Smoking cessation has no impact on COPD progression.

Answer: B. Airflow limitation in asthma is largely reversible, while in COPD it is not fully reversible.

37. Management of stable COPD aims to reduce the impact of the disease on the patient. This is achieved by focusing on:

• A. Only preventing exacerbations.
• B. Only improving FEV1.
• C. A dual strategy of reducing symptoms (improving health status) and reducing future risk (preventing exacerbations).
• D. Only treating comorbidities.

Answer: C. A dual strategy of reducing symptoms (improving health status) and reducing future risk (preventing exacerbations).

38. Which of the following would classify a COPD patient into GOLD Group A for initial treatment?

• A. High symptom burden (e.g., CAT ≥ 10) and frequent exacerbations (≥2 or ≥1 leading to hospitalization).
• B. Low symptom burden (e.g., CAT < 10) and 0 or 1 moderate exacerbation not leading to hospitalization.
• C. Low symptom burden but frequent exacerbations.
• D. High symptom burden but no exacerbations in the past year.

Answer: B. Low symptom burden (e.g., CAT < 10) and 0 or 1 moderate exacerbation not leading to hospitalization.

39. Long-term use of macrolides (e.g., azithromycin) in selected former smokers with COPD is for their:

• A. Direct bronchodilator effect.
• B. Anti-inflammatory and immunomodulatory properties to reduce exacerbations.
• C. Ability to improve FEV1 significantly.
• D. Antiviral activity.

Answer: B. Anti-inflammatory and immunomodulatory properties to reduce exacerbations.

40. A patient with COPD presents with increased sputum purulence. This finding increases the likelihood that the exacerbation is caused by:

• A. A viral infection only
• B. A bacterial infection, and strengthens the indication for antibiotics
• C. Air pollution
• D. Non-adherence to inhaler therapy

Answer: B. A bacterial infection, and strengthens the indication for antibiotics

41. Which of the following is NOT a primary goal of pulmonary rehabilitation for COPD?

• A. Improving exercise tolerance
• B. Reversing the underlying emphysematous changes
• C. Reducing the perception of dyspnea
• D. Promoting self-management and improving health-related quality of life

Answer: B. Reversing the underlying emphysematous changes

42. For a patient with COPD managed with a LAMA, who continues to have significant dyspnea, what is a common next step?

• A. Add a SABA on a scheduled basis.
• B. Add a LABA to create a LAMA/LABA dual therapy regimen.
• C. Discontinue the LAMA and start an ICS.
• D. Initiate long-term oxygen therapy.

Answer: B. Add a LABA to create a LAMA/LABA dual therapy regimen.

43. The risk of pneumonia is a recognized potential adverse effect associated with the use of which class of medications in COPD patients?

• A. Long-acting beta2-agonists (LABAs)
• B. Long-acting muscarinic antagonists (LAMAs)
• C. Inhaled corticosteroids (ICS)
• D. Roflumilast

Answer: C. Inhaled corticosteroids (ICS)

44. “Dynamic hyperinflation” in COPD occurs during exercise when:

• A. The patient’s breathing rate slows down.
• B. Air is trapped in the lungs due to incomplete exhalation before the next breath begins, leading to increased dyspnea.
• C. The airways paradoxically dilate.
• D. The heart rate decreases.

Answer: B. Air is trapped in the lungs due to incomplete exhalation before the next breath begins, leading to increased dyspnea. (Bronchodilators help reduce this).

45. A pharmacist’s role in COPD management includes:

• A. Performing diagnostic spirometry and interpreting the results to make a diagnosis.
• B. Counseling on smoking cessation, ensuring correct inhaler technique, managing medication adherence, and providing education on the disease.
• C. Prescribing controlled substances for dyspnea.
• D. Administering lung volume reduction surgery.

Answer: B. Counseling on smoking cessation, ensuring correct inhaler technique, managing medication adherence, and providing education on the disease.

46. Which of the following is a potential side effect of roflumilast that can limit its use?

• A. Hypertension and tachycardia
• B. Weight gain and edema
• C. Gastrointestinal effects (diarrhea, nausea) and weight loss; psychiatric effects can also occur
• D. Severe bronchospasm

Answer: C. Gastrointestinal effects (diarrhea, nausea) and weight loss; psychiatric effects can also occur

47. “Asthma-COPD Overlap” (ACO) is a phenotype characterized by:

• A. The presence of COPD symptoms only.
• B. The presence of asthma symptoms only.
• C. Persistent airflow limitation with features typically associated with both asthma (e.g., eosinophilic inflammation, significant bronchodilator reversibility) and COPD (e.g., significant smoking history, emphysema).
• D. A condition that is easier to treat than either asthma or COPD alone.

Answer: C. Persistent airflow limitation with features typically associated with both asthma (e.g., eosinophilic inflammation, significant bronchodilator reversibility) and COPD (e.g., significant smoking history, emphysema).

48. In the management of COPD, what is the role of theophylline?

• A. It is a first-line bronchodilator for all patients.
• B. It is considered an alternative or add-on therapy, but its use is limited by a narrow therapeutic index and significant potential for drug interactions.
• C. It is primarily used for its anti-inflammatory effects.
• D. It is a potent mucolytic agent.

Answer: B. It is considered an alternative or add-on therapy, but its use is limited by a narrow therapeutic index and significant potential for drug interactions.

49. When would you escalate a COPD patient in Group B (high symptoms, low exacerbation risk) from LAMA or LABA monotherapy to LAMA/LABA dual therapy?

• A. If they have had one moderate exacerbation.
• B. If they experience persistent dyspnea despite monotherapy.
• C. If their blood eosinophil count is >300 cells/µL.
• D. Group B patients should always start on dual therapy.

Answer: B. If they experience persistent dyspnea despite monotherapy.

50. The ultimate goal of managing stable COPD with pharmacological therapy is to:

• A. Cure the disease and normalize lung function.
• B. Reduce symptoms (dyspnea) and reduce the frequency and severity of exacerbations.
• C. Only prevent the need for oxygen therapy.
• D. Treat associated cardiovascular comorbidities only.

Answer: B. Reduce symptoms (dyspnea) and reduce the frequency and severity of exacerbations.