Pharmaceutical care of people with chronic obstructive pulmonary disease

1. COPD is a disease:
a characterised by reversible airways obstruction False
b which rarely occurs in patients under the age of 35 True
c in which symptoms rarely vary between days True
d which is linked to a chronic productive cough True

2. Severe COPD is defined as:

a an FEV1 of less than 50% of predicted by NICE / BTS False
b an FEV1 of less than 50% of predicted by ATS / ERS True
c an FEV1 of less than 50% of predicted by GOLD False
d an FEV1 of less than 30% of predicted by NICE / BTS True

3. When the diagnosis of COPD is considered the patient should also be questioned about:
a occupational history True
b dyspnoea according to the MRC dyspnoea scale True
c pets False
d ankle swelling True

4. Possible differential diagnosis considered when diagnosing COPD are:

a lung cancer True
b pneumothorax False
c heart failure True
d cystic fibrosis False

5. Patients with severe COPD:

a may have type II respiratory failure True
b should be managed with a combination of inhaled corticosteroid
and long acting beta agonist True
c will rarely be managed in hospital False
d are maintained on long term oxygen therapy for more than
20 hours a day False

6. A patient who has smoked:

a 15 cigarettes a day for 42 years has a smoking history of
greater than 30 pack years True
b 10 cigarettes a day for 30 years has a smoking history of 10 pack years False
c 20 cigarettes a day for 10 years has a smoking history of 10 pack years True
d 40 cigarettes a day for 30 years has a smoking history of greater
than 30 pack years True

7. Smoking cessation:
a in patients with COPD will return the patients FEV1 to normal for their age False
b in patients with COPD will return the rate of decline in FEV1 to normal True
c in patients with COPD will have no effect on lung function False
d is the most beneficial intervention for all patients with COPD True
8. The National institute for Health and Clinical Excellence (NICE)/British Thoracic Society
(BTS) guideline for the management of COPD indicate that all patients:
a with an exacerbation of COPD should be prescribed high dose
inhaled corticosteroids False
b admitted to hospital with an exacerbation of COPD should be
prescribed oral corticosteroids True
c should have therapy discontinued if it is shown to ineffective after
two weeks False
d should be referred pulmonary rehabilitation if they think that they
are functionally disabled by the disease True

9. The NICE / BTS guidelines for the management of COPD recommend:

a the use of as required short acting inhaled beta agonists True
b the use of anticholinergics True
c the use of ipratropium and tiotropium together False
d the use of combination inhalers in moderate to severe disease True

10. Patients with COPD should only be prescribed:

a inhaled corticosteroids if they have demonstrable reversibility False
b corticosteroids in an exacerbation if they have had a steroid trial False
c ipratropium if a short acting beta agonist has shown no benefit False
d a long acting beta agonist if they are also receiving an inhaled corticosteroid False

11. Patients with COPD demonstrate no increase in quality of life:

a when prescribed inhaled corticosteroids unless they demonstrate
reversibility False
b when prescribed tiotropiiumm rather than ipratropium False
c unless their FEV1 is also increased False
d when prescribed a combination of inhaled corticosteroids and
long-acting beta agonists False

12. Patients with COPD who are prescribed long term oxygen therapy (LTOT) at home
should:
a be encouraged to stop smoking True
b use cylinders as the preferred method of delivery False
c should have a concentrator ordered by their GP False
d should use a compressor and air to drive any nebulised medicines True

13. Patients with COPD:

a should have their nebulised drugs delivered by a nebuliser driven by oxygen False
b should have their nebulised drugs delivered by a nebuliser driven by air True
c which is severe should be prescribed a combination of an inhaled
corticosteroid and long acting beta agonist True
d which is moderate to severe should be prescribed tiotropium True
14. Other therapies which have shown usefulness in the management of COPD include:
a mucolytics True
b diuretics False
c theophylline True
d prophylactic antibacterial therapy False

15. One of the assessment criteria which favour home management of

exacerbations of COPD is that the patient:
a does not currently receive home oxygen therapy True
b lives alone False
c has an oxygen saturation above 80% False
d mild breathlessness True

16. Abrupt withdrawal of prednisolone following management of an exacerbation of COPD:

a may precipitate a further exacerbation of COPD False
b is acceptable if the patient has been on a high dose for less than 21 days True
c can be undertaken if the patient is not on a maintenance dose of
oral corticosteroids True
d cannot be undertaken if the patient is on high dose inhaled corticosteroids False

17. An infective exacerbation is characterised by:

a an increased volume of sputum and a cough False
b an increased volume of sputum and increased purulence of sputum True
c an increased volume of sputum and increased breathlessness True
d an increased volume of sputum and increased FEV1 False

18. The most common causative organisms of infective exacerbations of COPD are:
a Staphylococcus aureus False
b Streptococcus pneumonia True
c Haemophilus influenzae True
d Streptococcus faecalis False

19. An appropriate antibacterial for the management of an exacerbation of COPD is:

a. amoxicillin 500mg three times a day for a non-penicillin allergic patient True
b. amoxicillin 3g twice a day for non-penicillin allergic patients False
c. clarithromycin 500mg twice a day for a penicillin allergic patient True
d. penicillin V 500mg four times a day for a non-penicillin allergic patient False

20. The multidisciplinary team involved in the care of patients with COPD should include:
a. Pharmacists True
b. Dieticians True
c. Physiotherapists True
d. Occupational therapists True