CRE Risk Assessment & Management 2 — Questions and Answers
Question 1: A COPD patient reports waking up at night with breathlessness three times per week. Using the MRC Dyspnea Scale, which grade best reflects this level of functional impairment?
- Grade 1 — only breathless with strenuous exercise
- Grade 2 — short of breath when hurrying on level ground
- Grade 3 — walks slower than contemporaries on level ground
- Grade 4 — stops for breath after walking about 100 yards (Correct answer)
Correct answer: Grade 4 — stops for breath after walking about 100 yards
Nocturnal symptoms combined with significant activity limitation place the patient at MRC Grade 4, indicating severe dyspnea.
Question 2: Which spirometric criterion is the primary threshold used to confirm obstructive ventilatory defect in risk stratification for COPD?
- FVC < 80% predicted
- FEV1/FVC ratio < 0.70 post-bronchodilator (Correct answer)
- Peak expiratory flow < 60% predicted
- TLC > 120% predicted
Correct answer: FEV1/FVC ratio < 0.70 post-bronchodilator
A post-bronchodilator FEV1/FVC ratio below 0.70 is the GOLD standard criterion for diagnosing obstruction and initiating COPD risk stratification.
Question 3: A patient with asthma has used their rescue inhaler more than two days per week for the past month but has no nighttime awakenings and no activity limitation. According to NAEPP guidelines, how is asthma severity classified?
- Intermittent
- Mild persistent (Correct answer)
- Moderate persistent
- Severe persistent
Correct answer: Mild persistent
More than two rescue inhaler uses per week with no other impairment criteria meets the definition of mild persistent asthma.
Question 4: When assessing fall risk in an elderly patient with COPD on supplemental oxygen, which factor most directly increases that risk?
- Elevated BMI
- Oxygen tubing on the floor (Correct answer)
- FEV1 greater than 50% predicted
- Absence of peripheral edema
Correct answer: Oxygen tubing on the floor
Oxygen tubing creates a physical tripping hazard and is a modifiable environmental fall risk factor for ambulatory patients.
Question 5: A respiratory educator discovers that a patient with home mechanical ventilation has no backup power plan. Which risk category does this situation represent?
- Low risk — power outages are rare
- Moderate risk — batteries last 4–6 hours
- High risk — life-sustaining equipment depends on continuous power (Correct answer)
- Not a risk — ventilators have built-in alarms
Correct answer: High risk — life-sustaining equipment depends on continuous power
Dependence on mechanical ventilation without backup power constitutes a high-risk situation because interruption can be immediately life-threatening.
Question 6: Which validated tool is most appropriate for screening for anxiety and depression as comorbid risks in COPD patients during a respiratory education visit?
- STOP-BANG questionnaire
- Hospital Anxiety and Depression Scale (HADS) (Correct answer)
- Epworth Sleepiness Scale
- CAGE questionnaire
Correct answer: Hospital Anxiety and Depression Scale (HADS)
The HADS is a widely validated two-part screening tool for anxiety and depression specifically in patients with chronic illness.
Question 7: A patient with a history of pneumothorax asks about air travel risk. Which assessment finding most directly increases risk of in-flight complications?
- SpO2 of 96% at sea level
- Recent pneumothorax within the past 2–3 weeks (Correct answer)
- Mild intermittent asthma
- FVC 85% predicted
Correct answer: Recent pneumothorax within the past 2–3 weeks
A recent pneumothorax within 2–3 weeks is a contraindication to air travel due to expansion of residual gas at reduced cabin pressure.
CRE Risk Assessment & Management 2
A COPD patient reports waking up at night with breathlessness three times per week.
Using the MRC Dyspnea Scale, which grade best reflects this level of functional impairment?