#july2020mccqe1
A 65-year-old man with chronic obstructive pulmonary disease is evaluated in the emergency department for a 4-day history of worsening dyspnea, cough, and increased production of purulent sputum. His albuterol inhaler has been ineffective in relieving his symptoms. On physical examination, the patient is in respiratory distress using pursed-lip breathing. Temperature is 36.7°C (98.0°F), blood pressure is 145/84 mm Hg, pulse rate is 102/min, and respiration rate is 20/min. He has audible polyphonic wheezes but no crackles. Heart sounds are distant but otherwise normal. The remainder of his physical examination is normal. Arterial blood gases performed on 2 L/min nasal cannula: pH, 7.31; PCO2, 50 mm Hg (6.7 kPa); PO2, 65 mm Hg (8.6 kPa). Chest radiograph displays hyperinflation but no infiltrates. Intravenous corticosteroids and inhaled albuterol are begun. Which of the following treatments should also be initiated?
(A) Amoxicillin
(B) Inhaled corticosteroids
(C) Levofloxacin
(D) Theophylline
A 65-year-old man with chronic obstructive pulmonary disease is evaluated in the emergency department for a 4-day history of worsening dyspnea, cough, and increased production of purulent sputum. His albuterol inhaler has been ineffective in relieving his symptoms. On physical examination, the patient is in respiratory distress using pursed-lip breathing. Temperature is 36.7°C (98.0°F), blood pressure is 145/84 mm Hg, pulse rate is 102/min, and respiration rate is 20/min. He has audible polyphonic wheezes but no crackles. Heart sounds are distant but otherwise normal. The remainder of his physical examination is normal. Arterial blood gases performed on 2 L/min nasal cannula: pH, 7.31; PCO2, 50 mm Hg (6.7 kPa); PO2, 65 mm Hg (8.6 kPa). Chest radiograph displays hyperinflation but no infiltrates. Intravenous corticosteroids and inhaled albuterol are begun. Which of the following treatments should also be initiated?
(A) Amoxicillin
(B) Inhaled corticosteroids
(C) Levofloxacin
(D) Theophylline
Last edited by a moderator: