#may2020mccqe1
A 58-year-old man with chronic obstructive pulmonary disease (COPD) is evaluated for slowly progressive dyspnea beginning 6 months ago. He now has dyspnea with minimal exertion, such as walking two blocks, and he can no longer climb a flight of stairs. He has a 42-pack-year smoking history, quitting 2 years ago. His medications are albuterol and tiotropium inhalers. On physical examination, temperature is 36.6°C (97.8°F), blood pressure is 140/86 mm Hg, pulse rate is 90/min, and respiration rate is 16/min. Oxygen saturation by pulse oximetry is 87% on ambient air. Breath sounds are decreased, but no audible wheezes are present. Arterial blood gas analysis, on ambient air, reveals: pH, 7.38; PO2, 54 mm Hg (7.2 kPa); PCO2, 45 mm Hg (6.0 kPa). Chest radiograph shows hyperinflation. Spirometry shows an FEV1 of 30% of predicted and an FEV1/FVC ratio of 50%. Which of the following interventions is most likely to improve this patient's survival?
(A) Continuous oxygen therapy
(B) Inhaled corticosteroid
(C) Inhaled salmeterol
(D) Theophylline
A 58-year-old man with chronic obstructive pulmonary disease (COPD) is evaluated for slowly progressive dyspnea beginning 6 months ago. He now has dyspnea with minimal exertion, such as walking two blocks, and he can no longer climb a flight of stairs. He has a 42-pack-year smoking history, quitting 2 years ago. His medications are albuterol and tiotropium inhalers. On physical examination, temperature is 36.6°C (97.8°F), blood pressure is 140/86 mm Hg, pulse rate is 90/min, and respiration rate is 16/min. Oxygen saturation by pulse oximetry is 87% on ambient air. Breath sounds are decreased, but no audible wheezes are present. Arterial blood gas analysis, on ambient air, reveals: pH, 7.38; PO2, 54 mm Hg (7.2 kPa); PCO2, 45 mm Hg (6.0 kPa). Chest radiograph shows hyperinflation. Spirometry shows an FEV1 of 30% of predicted and an FEV1/FVC ratio of 50%. Which of the following interventions is most likely to improve this patient's survival?
(A) Continuous oxygen therapy
(B) Inhaled corticosteroid
(C) Inhaled salmeterol
(D) Theophylline
Last edited by a moderator: