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WorksheetsCOPD in primary care
Total questions: 21
Worksheet time: 11mins
A 60-year-old man presents with chronic cough and sputum production for the past 2 years. He smokes 20 cigarettes daily for 30 years.
What is the MOST likely diagnosis to consider?
Asthma
COPD
Chronic bronchitis secondary to infection
Lung cancer
Which of the following clinical features MOST strongly suggests COPD rather than asthma?
Onset before age 30 years
Symptoms vary day to day
Chronic cough and exertional dyspnoea that slowly worsens over years
Symptoms triggered by allergens
A non-smoker presents with chronic cough. He works in a cement factory for 20 years.
Which factor is MOST relevant in the pathogenesis of his condition?
Passive smoking
Biomass exposure
Occupational dust inhalation
Childhood infections
Which investigation is ESSENTIAL to confirm COPD diagnosis?
Chest X-ray
Peak expiratory flow measurement
Spirometry with post-bronchodilator reversibility
Arterial blood gas
A patient’s spirometry shows FEV₁ 60% predicted and FEV₁/FVC ratio of 0.6.
What is the GOLD severity grade?
GOLD 1 (mild)
GOLD 2 (moderate)
GOLD 3 (severe)
GOLD 4 (very severe)
Which finding helps distinguish asthma from COPD?
History of smoking
Chronic productive cough
Post-bronchodilator FEV₁ reversibility >12% and >200 mL
Dyspnoea on exertion
Which tool is commonly used in primary care to assess COPD symptom burden?
Asthma Control Test (ACT)
COPD Assessment Test (CAT)
MRC Dyspnoea Scale only
Borg Scale
A patient with COPD had 3 exacerbations in the past year. According to GOLD/CPG, this patient is:
Low risk
High risk
Moderate risk
Unclassified
Which comorbidity is MOST commonly associated with COPD?
Hypothyroidism
Osteoporosis and cardiovascular disease
Chronic kidney disease
Liver cirrhosis
A 65-year-old man with moderate COPD (CAT 8, 1 exacerbation) belongs to Group B.
What is the recommended first-line therapy?
Short-acting beta-agonist (SABA) only
Long-acting bronchodilator (LABA or LAMA)
ICS alone
Oral theophylline
In which scenario is inhaled corticosteroid (ICS) indicated in COPD?
All patients
Patients with frequent exacerbations and blood eosinophils ≥300/μL
Mild COPD
During stable phase only
Which non-drug intervention has the STRONGEST evidence for mortality reduction in COPD?
Pulmonary rehabilitation
Influenza vaccination
Smoking cessation
Nutritional support
An acute exacerbation of COPD is BEST defined as:
Sudden chest pain with cough
Worsening of dyspnoea, cough, or sputum beyond normal day-to-day variation
Any infection causing fever
Decrease in FEV₁ only
What is the recommended oral corticosteroid regimen for an acute exacerbation of COPD?
Prednisolone 10 mg daily for 5 days
Prednisolone 30–40 mg daily for 5 days
Dexamethasone 8 mg IM once
Hydrocortisone 200 mg IV bolus
Which of the following is an indication for urgent hospital referral in COPD exacerbation?
Increased sputum production only
Mild dyspnoea on exertion
SpO₂ <90% or confusion
New wheeze only
How often should a stable COPD patient be reviewed in primary care?
Every 3–6 months
Yearly
Only when symptomatic
Every week
Which parameter should ALWAYS be checked at follow-up?
Chest X-ray
Inhaler technique and adherence
Spirometry every visit
Blood gas analysis
Which vaccination is RECOMMENDED for COPD patients in primary care?
Typhoid vaccine
Hepatitis B vaccine
Annual influenza and pneumococcal vaccines
MMR vaccine
Which statement BEST describes the purpose of a COPD Action Plan?
Prevents all future exacerbations
Helps patients recognise and manage worsening symptoms early
Replaces regular clinic visits
Allows unsupervised steroid use
Which advice is MOST appropriate for a stable COPD patient?
Avoid all exercise to prevent dyspnoea
Participate in pulmonary rehabilitation and stay active
Restrict fluid intake
Avoid vaccinations
A 65-year-old smoker with COPD says, “It’s too late for me to quit now.”
What is the MOST appropriate response?
Agree and focus on other interventions
Emphasise that quitting slows disease progression at any stage
Tell him to quit abruptly without support
Prescribe steroids instead
