#february2020mccqe1
A 55-year-old man with a 7-year history of severe chronic obstructive pulmonary disease is evaluated after being discharged from the hospital following an acute exacerbation; he has had three exacerbations over the previous 18 months. He is a long-term smoker who stopped smoking 1 year ago. His medications are albuterol as needed and inhaled tiotropium and salmeterol. On physical examination, vital signs are normal. Breath sounds are decreased bilaterally; there is no edema or cyanosis. Oxygen saturation after exertion is 92% on ambient air. Spirometry shows an FEV1 of 32% of predicted and an FEV1/FVC ratio of 40%. Chest radiograph done in the hospital 3 weeks ago showed no active disease.
Which of the following medications should now be initiated?
(A) An inhaled corticosteroid
(B) Ipratropium
(C) N-acetylcysteine
(D) Oral prednisone
A 55-year-old man with a 7-year history of severe chronic obstructive pulmonary disease is evaluated after being discharged from the hospital following an acute exacerbation; he has had three exacerbations over the previous 18 months. He is a long-term smoker who stopped smoking 1 year ago. His medications are albuterol as needed and inhaled tiotropium and salmeterol. On physical examination, vital signs are normal. Breath sounds are decreased bilaterally; there is no edema or cyanosis. Oxygen saturation after exertion is 92% on ambient air. Spirometry shows an FEV1 of 32% of predicted and an FEV1/FVC ratio of 40%. Chest radiograph done in the hospital 3 weeks ago showed no active disease.
Which of the following medications should now be initiated?
(A) An inhaled corticosteroid
(B) Ipratropium
(C) N-acetylcysteine
(D) Oral prednisone
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