14. Which one of the following is not a protective factor against OSAS in COPD?  Low BMI.  Reduced diaphragmatic efficiency due to lung hyperinflation.  Diminished REM sleep.  Medication: theophylline. 15. Which of the following responses is not a result of intermittent hypoxia associated with OSAS in contributing to cardiovascular diseases?  Increased sympathetic nervous system.  Systemic inflammation and oxidative stress.  Downregulation of the transcription factor NF-κB pathway.  Insulin dysregulation. 16. With regard to overlap syndrome, which one of the following statements is false?  Daytime hypercapnia and nocturnal hypoxaemia lead to pulmonary hypertension.  The severity of obstructive ventilatory impairment was inversely correlated with the severity of sleep disordered breathing.  The inspiratory capacity to total lung capacity ratio correlates with sleep efficiency.  Treatment with nasal CPAP can reduce the CT 90. 17. Which one of the following statements is true?  COPD can increase depressive symptoms.  COPD can increase anxiety.  COPD can severely negatively affect the quality of life.  All of the above. 18. Which one of the following statements is true? A high score on a mental health screening scale:  Is diagnostic of a mental disorder.  Should be ignored because of somatic overlap with ageing and COPD.  Should be investigated by a clinician with mental health expertise and treated if appropriate.  Is likely to be a false positive. 19. Which one of the following statements is false?  Depression and anxiety are risk factors for initiating tobacco smoking.  Smoking rates amongst those with severe mental illnesses are high.  Failure of a tobacco-cessation attempt is not linked to having depressive symptoms.  Smoking cessation itself may induce depressive symptoms in individuals with a history of depression. 20. When treating patients with COPD who also have depression, which one of the following statements is true?  Cognitive behaviour therapy is indicated for those with severe depression.  The safest and most effective pharmacotherapy is amitriptyline.  There is level I evidence from COPD populations supporting the use of monoamine oxidase inhibitors.  Selective serotonin re-uptake inhibitors are the preferred first-line therapies for controlling depression symptoms. 21. When treating patients with COPD who have an anxiety disorder, which one of the following statements is true?  Low-intensity cognitive behaviour therapy-based interventions are recommended first-line treatment.  Pulmonary rehabilitation has level II evidence for improving control of anxiety symptoms.  Benzodiazepines are recommended first-line therapy to control panic disorder in COPD patients.  Interpersonal therapy is contraindicated for social anxiety disorders. 22. Which one of the following statements is true?  Anxiety symptoms should not influence the course or treatment of COPD.  Depression is part of the normal clinical spectrum of COPD and requires no targeted treatment beyond the usual management of COPD.  Because anxiety and depression are so common in COPD, cognitive behaviour therapy should be a core component of COPD management.  People with COPD who also have clinical depression have worse health-related quality of life and more hospitalisations than those without comorbid depression. 227 Continued on next page