Respiratory medicine: roflumilast: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Respiratory medicine: roflumilast

Sample item

A 66-year-old ex-smoker with chronic bronchitis, FEV1 of 40% predicted and frequent exacerbations continues to exacerbate despite triple inhaled therapy. Roflumilast is added. What is its mechanism of action?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Selective phosphodiesterase 4 inhibition, raising cAMP in inflammatory cells

Roflumilast inhibits phosphodiesterase 4, increasing cAMP in inflammatory cells and reducing airway inflammation. It lowers exacerbations in severe COPD with chronic bronchitis, and common adverse effects are diarrhoea, weight loss and nausea.

Option by option

  • A. Selective phosphodiesterase 4 inhibition, raising cAMP in inflammatory cells (correct)

    Correct. Phosphodiesterase 4 inhibition increases cAMP and dampens airway inflammation.

  • B. Long-acting antagonism of muscarinic M3 receptors

    Muscarinic antagonism is the action of tiotropium, which he already takes.

  • C. Cysteinyl leukotriene receptor blockade in the airways

    Leukotriene receptor blockade is the action of montelukast.

  • D. Inhibition of IgE binding to mast cells

    Blocking IgE binding is the action of omalizumab.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Selective phosphodiesterase 4 inhibition, raising cAMP in inflammatory cells. Roflumilast inhibits phosphodiesterase 4, increasing cAMP in inflammatory cells and reducing airway inflammation.

Why is "Long-acting antagonism of muscarinic M3 receptors" not the answer?

Muscarinic antagonism is the action of tiotropium, which he already takes.

Why is "Cysteinyl leukotriene receptor blockade in the airways" not the answer?

Leukotriene receptor blockade is the action of montelukast.

Why is "Inhibition of IgE binding to mast cells" not the answer?

Blocking IgE binding is the action of omalizumab.

What concept does this question test?

It tests Respiratory medicine: roflumilast in General Medicine. It lowers exacerbations in severe COPD with chronic bronchitis, and common adverse effects are diarrhoea, weight loss and nausea.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Respiratory medicine: roflumilast?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.