Questions … cases

Question 1

Case

A 64-year-old man with COPD and poorly controlled type 2 diabetes presents with progressive decline in lung function.

Which mechanism best explains how diabetes worsens COPD?

A) Bronchial smooth muscle AGE binding
B) Insulin resistance causing bronchospasm
C) Thick airway mucus from hyperglycemia
D) Hyperglycemia-induced oxidative stress

Answer:
D) Hyperglycemia-induced oxidative stress

Explanation (Very Short)
Hyperglycemia increases oxidative stress, leading to lung tissue damage and impaired repair.

Clinical Pearl
Poor glycemic control accelerates COPD progression.

Question 2

Case

A 70-year-old COPD patient presents with acute dyspnea and wheezing. Treatment for COPD exacerbation gives minimal improvement.

Which condition commonly mimics COPD exacerbation?

A) Guillain-Barré syndrome
B) Interstitial pneumonitis
C) Constrictive pericarditis
D) Heart failure

Answer:
D) Heart failure

Explanation (Short)
Heart failure frequently presents with dyspnea and pulmonary congestion, resembling COPD exacerbation.

Clinical Pearl
Always consider HF, pneumonia, and PE in suspected COPD exacerbation.

Question 3

Case

A patient with COPD and diabetes develops worsening dyspnea and peripheral edema after starting a new diabetes medication.

Which drug class may worsen respiratory symptoms?

A) GLP-1 receptor agonists
B) Metformin
C) SGLT2 inhibitors
D) Thiazolidinediones (TZDs)

Answer:
D) Thiazolidinediones (TZDs)

Explanation (Short)
TZDs may cause fluid retention, leading to pulmonary congestion.

Clinical Pearl
Use TZDs cautiously in COPD or heart failure risk.

 

Question 4

Case

A COPD patient with frequent exacerbations reports persistent sadness, anxiety, and social withdrawal.

Which comorbidity is associated with higher COPD exacerbation rates?

A) Pulmonary hypertension
B) Obstructive sleep apnea
C) Depression
D) Arrhythmia

Answer:
C) Depression

Explanation (Short)
Depression and anxiety increase exacerbations, healthcare use, and mortality.

Clinical Pearl
Treating mental health improves COPD outcomes.