COPD Practice Questions

30 multiple-choice questions on COPD for paramedic and EMT students, from Chapter 17 (Respiratory Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. Chronic bronchitis is clinically defined by a productive cough lasting at least:

   1. A. 2 weeks in each of 5 consecutive years
   2. B. 1 month in each of 3 consecutive years
   3. C. 6 weeks in each of 2 consecutive years
   4. D. 3 months in each of 2 consecutive years
   Show answer

   Answer: D. 3 months in each of 2 consecutive years

   Chronic bronchitis is defined as a productive cough for at least 3 months a year for 2 consecutive years, without another explanation.

2. A COPD patient with a history of CO2 retention needs a nebulized bronchodilator. Your ambulance has compressed air and oxygen. How should the nebulizer be driven?

   1. A. With oxygen at 15 L/min through a nonrebreather mask
   2. B. With oxygen, then take the oxygen away afterward
   3. C. With room air and no added oxygen
   4. D. With air, adding oxygen by nasal cannula as needed
   Show answer

   Answer: D. With air, adding oxygen by nasal cannula as needed

   In patients at risk of hypercapnia, a nebulizer run on oxygen at 6 to 8 L/min can push the SpO2 well above target. BTS advises driving it with air and giving oxygen separately by nasal cannula to keep 88% to 92% (if only oxygen is available, limit it to about 6 minutes). A nonrebreather adds even more oxygen. Removing all oxygen afterward ignores her hypoxemia. Withholding oxygen entirely is unsafe if she is hypoxemic.

3. What is the leading cause of COPD in the United States?

   1. A. Cigarette smoking
   2. B. Alpha-1 antitrypsin deficiency
   3. C. Childhood asthma
   4. D. Occupational dust exposure
   Show answer

   Answer: A. Cigarette smoking

   Tobacco smoke is by far the most common cause. Alpha-1 antitrypsin deficiency is a rare genetic cause of early-onset emphysema.

4. A thin 68-year-old man with a barrel chest breathes through pursed lips and has pink skin. This classic presentation is most consistent with:

   1. A. Acute asthma
   2. B. Emphysema
   3. C. Pulmonary edema
   4. D. Chronic bronchitis
   Show answer

   Answer: B. Emphysema

   The 'pink puffer' of emphysema is thin, uses pursed-lip breathing, and maintains oxygenation through increased work of breathing.

5. An overweight 62-year-old with chronic productive cough, cyanosis, and peripheral edema fits the classic description of:

   1. A. Emphysema
   2. B. Pulmonary embolism
   3. C. Chronic bronchitis
   4. D. Spontaneous pneumothorax
   Show answer

   Answer: C. Chronic bronchitis

   The 'blue bloater' of chronic bronchitis tends toward hypoxemia, cyanosis, and right heart failure (cor pulmonale) with edema.

6. A drowsy COPD patient on high-flow oxygen has a coarse flapping tremor when he holds his hands out, warm flushed skin, and a headache. What do these findings suggest?

   1. A. A low blood glucose level
   2. B. Rising CO2 (hypercapnia)
   3. C. An early stroke in one hemisphere
   4. D. Withdrawal from alcohol
   Show answer

   Answer: B. Rising CO2 (hypercapnia)

   A flapping tremor (asterixis), drowsiness, headache, and warm, flushed skin with a bounding pulse are signs of CO2 retention; titrate oxygen to 88% to 92% and support ventilation. Check glucose, but hypoglycemia causes cool, sweaty skin rather than asterixis. A stroke causes focal deficits. Alcohol withdrawal causes a fine tremor with agitation, not drowsiness.

7. A 12-lead ECG on a patient with long-standing COPD shows tall, peaked P waves in lead II. What do these most suggest?

   1. A. An acute inferior myocardial infarction
   2. B. High potassium from kidney failure
   3. C. Right atrial enlargement from lung disease
   4. D. Left ventricular hypertrophy from hypertension
   Show answer

   Answer: C. Right atrial enlargement from lung disease

   Tall, peaked P waves in lead II (P pulmonale, over 2.5 mm) reflect right atrial enlargement from pulmonary hypertension, common in chronic lung disease. Inferior MI shows ST elevation in II, III, and aVF, not P-wave changes. Hyperkalemia peaks the T waves, not the P waves. LVH increases QRS voltage in the left-sided leads.

8. A COPD patient hands you a card from her lung doctor that reads "Oxygen alert: target saturation 88% to 92%." How should you use it?

   1. A. Ignore it and aim for 100%
   2. B. Titrate her oxygen to that range
   3. C. Aim for 94% to 98% instead
   4. D. Give a fixed 2 L/min whatever the SpO2
   Show answer

   Answer: B. Titrate her oxygen to that range

   Oxygen alert cards identify patients known to be at risk of CO2 retention and give their target saturation, so titrate oxygen (often with a Venturi mask or low-flow cannula) to 88% to 92%. Aiming for 100% risks hypercapnia. The general 94% to 98% target is the one the card replaces for her, and a fixed flow without titration can leave her hypoxemic or hypercapnic.

9. An anxious COPD patient in moderate distress asks you to give her the lorazepam she keeps at home. What is the main concern?

   1. A. It will make her bronchospasm much worse
   2. B. It speeds up her heart rate
   3. C. It can depress her breathing and raise CO2
   4. D. It interacts dangerously with her albuterol
   Show answer

   Answer: C. It can depress her breathing and raise CO2

   Benzodiazepines blunt the drive to breathe, and a COPD patient with little reserve can slide into hypercapnic failure; treat the cause of the dyspnea instead. Lorazepam does not cause bronchospasm. It tends to slow, not speed, the heart rate. It has no important interaction with albuterol.

10. A COPD patient has a "flare" with sudden pleuritic chest pain and tachycardia, but no change in her sputum. She was in the hospital last week. Which condition should you also consider?

    1. A. Pulmonary embolism
    2. B. A typical infectious exacerbation
    3. C. Seasonal allergic rhinitis
    4. D. Hyperventilation syndrome
    Show answer

    Answer: A. Pulmonary embolism

    GOLD lists pulmonary embolism as an important mimic of a COPD exacerbation, especially with sudden onset, pleuritic pain, tachycardia, recent hospitalization, and no change in sputum. Infectious exacerbations usually bring more or discolored sputum. Allergic rhinitis does not cause pleuritic pain or tachycardia. Hyperventilation is a diagnosis of exclusion.

11. Which systemic steroid course does GOLD recommend for most COPD exacerbations?

    1. A. Prednisone 40 mg daily for 5 days
    2. B. Prednisone 60 mg daily for 4 weeks
    3. C. Methylprednisolone 1 g IV daily for 3 days
    4. D. One dose of dexamethasone 0.6 mg/kg
    Show answer

    Answer: A. Prednisone 40 mg daily for 5 days

    GOLD recommends prednisone 40 mg a day for 5 days, which works as well as longer courses with less steroid exposure. Four weeks of high-dose prednisone adds side effects without benefit. Gram doses of methylprednisolone are for other diseases. Dexamethasone 0.6 mg/kg is a pediatric croup dose.

12. A COPD patient on long-term home oxygen asks why her doctor wants her to wear it most of the day, including while sleeping. What is the best answer?

    1. A. It cures the damage to her lungs over time
    2. B. It is needed just during exercise
    3. C. At least 15 hours daily improves survival
    4. D. It replaces the need for her daily inhalers
    Show answer

    Answer: C. At least 15 hours daily improves survival

    Trials of long-term oxygen therapy in COPD with severe resting hypoxemia showed improved survival when oxygen was used for at least 15 hours a day. Oxygen does not cure the damage to her lungs. Using it just during exercise does not give that benefit when she is hypoxemic at rest. It does not replace her daily inhalers, which are still needed.

13. A COPD patient's inhaler contains fluticasone, umeclidinium, and vilanterol. How should this inhaler be used?

    1. A. Repeated puffs each 20 minutes during an attack
    2. B. As her fast-acting rescue inhaler
    3. C. Once daily for maintenance, not for rescue
    4. D. Just on days she feels short of breath
    Show answer

    Answer: C. Once daily for maintenance, not for rescue

    This is a triple maintenance inhaler (inhaled steroid, long-acting anticholinergic, and long-acting beta agonist) taken once daily to prevent exacerbations. It is not designed for repeated rescue dosing, and taking it every 20 minutes risks an overdose of the long-acting drugs. Albuterol is the rescue drug. Using it just on bad days defeats its purpose.

14. A COPD patient's usual baseline SpO2 is 89%. What does this mean for your assessment?

    1. A. It calls for high-flow oxygen
    2. B. It rules out an exacerbation
    3. C. It shows acute respiratory failure
    4. D. It may be normal for this patient
    Show answer

    Answer: D. It may be normal for this patient

    Chronically hypoxemic patients may have a low baseline. Compare with the patient's usual values and focus on the trend and clinical picture. A baseline of 89% is within the 88% to 92% target for many COPD patients, so by itself it does not call for high-flow oxygen or signal acute failure, and it does not rule out an exacerbation.

15. A COPD patient in severe distress tells you her dry powder inhaler "isn't working today." What is the likely reason?

    1. A. It needs a strong, fast breath to release the drug
    2. B. Dry powder inhalers expire within one day of opening
    3. C. Dry powder drugs need a spacer to work
    4. D. It must be shaken hard before each dose
    Show answer

    Answer: A. It needs a strong, fast breath to release the drug

    Dry powder inhalers depend on the patient's own fast inhalation to pull the powder out; in severe distress she may not generate enough flow, so a nebulizer or an MDI with spacer works better. Most dry powder inhalers last weeks after opening. Spacers are used with metered-dose inhalers, not dry powder devices. Shaking is needed for many MDIs, not dry powder inhalers.

16. A COPD patient who smokes two packs a day has an SpO2 of 95% on room air. Why might his true oxygen content be lower than the reading suggests?

    1. A. Nicotine makes the oximeter probe overheat
    2. B. Smoking lowers the number of red blood cells
    3. C. Tar stains on the fingers block the probe's light
    4. D. Carbon monoxide reads as oxygenated hemoglobin
    Show answer

    Answer: D. Carbon monoxide reads as oxygenated hemoglobin

    Heavy smokers can carry carboxyhemoglobin levels of about 5% to 10%, which a standard pulse oximeter counts as oxyhemoglobin, so the SpO2 overstates real oxygen carrying. Nicotine does not affect the probe. Smokers tend to have more, not fewer, red cells. Nicotine staining usually has little effect, and the oximeter reads through it.

17. A 60-year-old woman with COPD has never smoked but cooked over open wood fires indoors for 40 years. Which exposure most likely caused her disease?

    1. A. Secondhand smoke from a single relative
    2. B. Childhood measles infection
    3. C. Regular exposure to cold, dry air
    4. D. Indoor smoke from burning biomass fuel
    Show answer

    Answer: D. Indoor smoke from burning biomass fuel

    Worldwide, smoke from burning wood, dung, and crop waste indoors is a leading cause of COPD in people who never smoked, especially women who cook over open fires. Secondhand smoke adds risk but is a smaller exposure here. Measles in childhood and cold air are not recognized major causes.

18. A COPD patient has a POLST marked "Do not intubate" with selective treatment. She is alert and in severe hypercapnic distress. What is appropriate?

    1. A. No treatment, because she declined intubation
    2. B. Intubation anyway, because her distress is severe
    3. C. Noninvasive ventilation, if it fits her wishes
    4. D. Comfort care alone, with oxygen withheld from her
    Show answer

    Answer: C. Noninvasive ventilation, if it fits her wishes

    A "do not intubate" order with selective treatment allows noninvasive support such as CPAP or BiPAP, bronchodilators, and oxygen, while intubation is declined. Declining intubation is not declining all care. Intubating her overrides a valid order. Withholding oxygen goes beyond what the order asks.

19. A COPD patient on home oxygen at 2 L/min is in distress. Her concentrator alarm is sounding and the tubing is kinked. What should you do first?

    1. A. Switch her to your oxygen supply
    2. B. Start CPAP before checking the line
    3. C. Increase her concentrator to 10 L/min
    4. D. Call her oxygen supplier first
    Show answer

    Answer: A. Switch her to your oxygen supply

    Correct the equipment problem by switching to your own oxygen and titrate to effect. Then reassess her symptoms. Starting CPAP before fixing a simple supply failure skips the obvious cause, calling the supplier delays oxygen, and raising the concentrator flow does nothing while the tubing is kinked.

20. An intubated COPD patient's EtCO2 is 52 mmHg, but an arterial blood gas drawn at the same time shows a PaCO2 of 70 mmHg. What best explains the gap?

    1. A. The capnograph reads a fixed 18 mmHg high
    2. B. Poorly perfused lung units dilute the exhaled CO2
    3. C. The ET tube must be in the esophagus
    4. D. CO2 keeps rising in the blood sample after it is drawn
    Show answer

    Answer: B. Poorly perfused lung units dilute the exhaled CO2

    In COPD, many ventilated alveoli are poorly perfused (dead space), so they exhale little CO2 and dilute the end-tidal value, making EtCO2 underestimate PaCO2. Follow trends rather than the absolute number. Capnographs do not read a fixed amount high. An esophageal tube would show no sustained waveform. CO2 does not climb meaningfully in a properly handled blood sample.

21. GOLD defines a COPD exacerbation as an event in which dyspnea, cough, or sputum worsens over what period?

    1. A. 6 months or more
    2. B. 14 days or less
    3. C. 24 hours or less
    4. D. At least 3 months
    Show answer

    Answer: B. 14 days or less

    Since 2023, GOLD has defined an exacerbation as worsening dyspnea and/or cough and sputum developing over 14 days or less, often with tachypnea or tachycardia. Six months or 3 months describes chronic disease. Many exacerbations build over several days, so a 24-hour limit would miss them.

22. A home-oxygen patient with COPD is smoking at the time of your arrival. What is the greatest immediate hazard?

    1. A. Fire from oxygen enrichment
    2. B. Oxygen toxicity seizures
    3. C. Nicotine-induced bronchospasm
    4. D. Carbon dioxide narcosis
    Show answer

    Answer: A. Fire from oxygen enrichment

    Oxygen supports combustion, and smoking while on oxygen causes serious facial and airway burns and house fires.

23. Which medication is a long-acting anticholinergic commonly used for COPD maintenance?

    1. A. Tiotropium
    2. B. Albuterol
    3. C. Prednisone
    4. D. Montelukast
    Show answer

    Answer: A. Tiotropium

    Tiotropium is a once-daily long-acting muscarinic antagonist used for COPD maintenance and is not a rescue drug.

24. A COPD patient's chief complaint is worsening dyspnea, fever, and green sputum for 3 days. Which condition must you also consider?

    1. A. Epiglottitis
    2. B. Pneumonia
    3. C. Croup
    4. D. Hyperventilation syndrome
    Show answer

    Answer: B. Pneumonia

    Pneumonia commonly complicates COPD and may cause sepsis. Look for fever, focal crackles, and signs of hypoperfusion.

25. A COPD patient's portable liquid oxygen unit leaked onto her hand while she refilled it. Her fingers are white, numb, and hard. What injury is this?

    1. A. A chemical burn from the oxygen reacting with skin
    2. B. A cold injury like frostbite from liquid oxygen
    3. C. A thermal burn from the oxygen catching fire
    4. D. An allergic reaction to the oxygen tubing
    Show answer

    Answer: B. A cold injury like frostbite from liquid oxygen

    Liquid oxygen is stored at about -183 °C, so a spill can freeze tissue on contact; treat it like frostbite with gentle rewarming and no rubbing. Oxygen does not chemically burn skin. Fire causes a heat burn with charring, which did not happen. Tubing allergy causes a rash, not frozen fingers.

26. What is a common long-term complication of chronic hypoxemia in COPD?

    1. A. Hyperthyroidism
    2. B. Thrombocytopenia
    3. C. Hypocalcemia
    4. D. Polycythemia
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    Answer: D. Polycythemia

    Chronic hypoxemia stimulates erythropoietin and red cell production, raising the hematocrit and blood viscosity.

27. A COPD patient says a small handheld fan pointed at her face helps when she is breathless at home. How should you respond?

    1. A. It is unsafe because it lowers her SpO2
    2. B. It should replace her rescue inhaler
    3. C. It is a recommended aid for breathlessness
    4. D. It helps by adding extra oxygen to the air
    Show answer

    Answer: C. It is a recommended aid for breathlessness

    GOLD recommends a handheld fan for chronic breathlessness; cool air on the face stimulates nerves that reduce the sensation of dyspnea. It does not lower SpO2. It does not treat bronchospasm, so it cannot replace her rescue inhaler. It moves room air and does not add oxygen.

28. A COPD patient on home oxygen is in moderate distress. Which history detail best helps you choose today's oxygen flow?

    1. A. Her usual home oxygen flow and SpO2
    2. B. How many years she has had COPD
    3. C. Her pack-year history of cigarette smoking
    4. D. Her most recent peak flow
    Show answer

    Answer: A. Her usual home oxygen flow and SpO2

    Knowing her usual flow (for example, 2 L/min) and usual saturation gives you a starting point and a target close to her baseline, avoiding both under- and over-oxygenation. Years since diagnosis, pack-years and peak flow describe her disease but do not tell you the flow or saturation that is normal for her.

29. Percussion over both sides of a COPD patient's chest is hyperresonant, and breath sounds are diminished but equal. What does this suggest?

    1. A. Bilateral tension pneumothorax from the COPD
    2. B. Large pleural effusions on both sides
    3. C. Consolidation of both lower lobes
    4. D. Chronic hyperinflation from trapped air
    Show answer

    Answer: D. Chronic hyperinflation from trapped air

    Even hyperresonance with equal, diminished breath sounds on both sides fits the chronic air trapping of emphysema. A tension pneumothorax is usually one-sided and comes with shock and severe distress. Effusions and consolidation make percussion dull, not hyperresonant.

30. According to GOLD, spirometry confirms COPD when the post-bronchodilator FEV1/FVC ratio is:

    1. A. Less than 0.70
    2. B. Greater than 0.80
    3. C. Exactly 1.0
    4. D. Between 0.85 and 0.90
    Show answer

    Answer: A. Less than 0.70

    GOLD defines persistent airflow limitation as a post-bronchodilator FEV1/FVC below 0.70, meaning less than 70% of the vital capacity can be exhaled in the first second. Ratios above 0.80 are normal. A ratio of 1.0 or 0.85 to 0.90 would be seen with normal airflow or restrictive disease, not obstruction.