#may2020mccqe1
A 72-year-old woman is evaluated for fatigue and decreased exercise capacity. She has severe chronic obstructive pulmonary disease, which was first diagnosed 10 years ago. She was hospitalized 1 month ago for her second exacerbation this year. She stopped smoking 5 years ago. She has no other significant medical problems. Her medications are albuterol as needed, an inhaled corticosteroid, a long-acting bronchodilator, and oxygen, 2 L/min by nasal cannula. On physical examination, vital signs are normal. Breath sounds are decreased. Spirometry done 1 month ago showed an FEV1 of 28% of predicted, and blood gases measured at that time (on supplemental oxygen) showed a pH of 7.41, PCO2 of 43 mm Hg (5.7 kPa), and PO2 of 64 mm Hg (8.4 kPa); DLCO is 30% of predicted. There is no nocturnal oxygen desaturation. Chest radiograph at this time shows hyperinflation. CT scan of the chest shows homogeneous distribution of emphysema. Which of the following is the most appropriate management for this patient?
(A) Lung transplantation
(B) Lung volume reduction surgery
(C) Nocturnal assisted ventilation
(D) Pulmonary rehabilitation
A 72-year-old woman is evaluated for fatigue and decreased exercise capacity. She has severe chronic obstructive pulmonary disease, which was first diagnosed 10 years ago. She was hospitalized 1 month ago for her second exacerbation this year. She stopped smoking 5 years ago. She has no other significant medical problems. Her medications are albuterol as needed, an inhaled corticosteroid, a long-acting bronchodilator, and oxygen, 2 L/min by nasal cannula. On physical examination, vital signs are normal. Breath sounds are decreased. Spirometry done 1 month ago showed an FEV1 of 28% of predicted, and blood gases measured at that time (on supplemental oxygen) showed a pH of 7.41, PCO2 of 43 mm Hg (5.7 kPa), and PO2 of 64 mm Hg (8.4 kPa); DLCO is 30% of predicted. There is no nocturnal oxygen desaturation. Chest radiograph at this time shows hyperinflation. CT scan of the chest shows homogeneous distribution of emphysema. Which of the following is the most appropriate management for this patient?
(A) Lung transplantation
(B) Lung volume reduction surgery
(C) Nocturnal assisted ventilation
(D) Pulmonary rehabilitation
Last edited by a moderator: