Exacerbations of Chronic Obstructive Pulmonary Disease Nadia K. Ali, MD, MBBS Dr. Ali is an academic internist, Department of Medicine, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, PA. The questions below are based on the article “Evidence-Based Approach to Acute Exacerbations of Chronic Obstructive Pulmonary Disease”. Choose the single best answer for each question.
	1. What is the most common cause of chronic obstructive pulmonary disease (COPD)? Air pollution Airway hyperreactivity α1-Antitrypsin deficiency Cigarette smoking Occupational exposure Click here to compare your answer. 2. A 50-year-old man presents to the emergency department and is diagnosed with an acute exacerbation of COPD. The patient has a history of diabetes mellitus, chronic kidney disease, and frequent COPD exacerbations. On examination, his vital signs are as follows: blood pressure, 150/90 mm Hg; respiratory rate, 24 breaths/min; temperature, 97.6°F; heart rate, 96 bpm; oxygen saturation, 94% on 2 L/min via nasal cannula, 88% on room air. What is the next best step in managing his COPD exacerbation appropriately? Admit to hospital Admit to intensive care unit Immediate intubation Manage as outpatient More information is required prior to making a decision regarding appropriate triaging of this patient Click here to compare your answer. 3. A 60-year-old woman with a 40-pack-year history of smoking is admitted to the hospital due to a COPD exacerbation. Which of the following treatments will lead to prevention of further exacerbations? Antibiotics and bronchodilators Bronchodilators and steroids Patient education and antibiotics Patient education and steroids Steroids and oxygen Click here to compare your answer.		4. The patient is started on intravenous steroids, antibiotics, and frequent nebulizer treatments. Analysis of arterial blood gas (ABG) several hours following the initiation of treatment reveals worsening hypercapnia and respiratory acidosis compared with the ABG drawn in the emergency department. What is the next best step in managing this patient’s hypercapnia and acidosis? Immediate institution of oxygen Immediate intubation Institution of bilateral positive airway pressure Institution of intravenous sodium bicarbonate drip Transfer to the intensive care unit Click here to compare your answer. 5. Which of the following is not a contraindication to using bilateral positive airway pressure? Acidosis Burns Copious secretions Impaired mental function Respiratory arrest Click here to compare your answer. 6. Which of the following interventions following discharge of a patient admitted with an acute exacerbation of COPD will reduce the risk of future hospitalization? Home nebulizer treatments Long-acting bronchodilators Oxygen therapy at home Prophylactic antibiotics Pulmonary rehabilitation Click here to compare your answer.
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