CLIN MED Pulm | QUESTIONS With 100%
Complete Solutions
Mucous gland enlargement and goblet cell hyperplasia is associated with
chronic bronchitis
dyspnea, chronic cough that is productive of phlegm, 40 pack-years of smoking,
wheezes/rales on PE
chronic bronchitis
enlarged air spaces secondary to alveolar destruction
emphysema
A patient with severe COPD presents to the Emergency Department with a 3 day history of
increasing shortness of breath with exertion and cough productive of purulent sputum. An
arterial blood gas reveals a pH of 7.25, PaCO2 of 70 mmHg and PaO2 of 50 mmHg. He is
started on albuterol nebulizer, nasal oxygen at 2 liters per minute, and an IV is started.
After one hour of treatment, his arterial blood gas now reveals a pH of 7.15, PaCO2 100
mmHg and PaO2 of 70 mmHg. What is the most appropriate next step in his treatment?
This person has increasing respiratory failure as indicated by the raising PaCO2 levels.
Intubation is required at this time.
A 73-year-old obese female with a 20 pack year smoking history presents complaining of
chronic productive cough. She states that it has been occurring over the past 3 years more
frequently November through February. What pulmonary function test values would you
expect to find decreased?
,FEV1/FVC
A 75 year-old man with a long history of COPD presents with acute onset of worsening
dyspnea, increased productive cough, and marked agitation. While in the emergency
department he becomes lethargic and obtunded. His ABG's reveal a PaO2 40 mmHg,
PaCO2 65 mmHg, and arterial pH 7.25. Which of the following is the most appropriate
management at this point?
This patient is in severe respiratory arrest with markedly impaired mental status; endotracheal
intubation and mechanical ventilation is required.
In patients with COPD, what has been shown to decrease rate of malignancy and
cardiovascular disease and improve survival?
smoking cessation
A 45 year-old male presents with complaints of a chronic cough productive of
mucopurulent sputum. The cough has been present for the past 3 years, but he attributed it
to a "smoker's cough". He has been coughing up a lot of sputum lasting all winter long for
the past 2 years. He denies any hemoptysis, weight loss or chest pain. Physical examination
reveals a moderately obese male in no acute respiratory distress. Lung fields reveal
presence of scattered rhonchi and wheezes. There is 1+ peripheral edema. What is the most
likely diagnosis?
Chronic bronchitis
A 56 year-old male with a 40 pack-year smoking history presents complaining of
progressive shortness of breath. Spirometry reveals an FEV1 of 2 L (40% of predicted), an
,FVC of 4 L (80% of predicted) and an FEV1/FVC of 50%. These findings are most
consistent with
chronic bronchitis
A 55 year-old man with a history of chronic bronchitis presents with two days of increased
dyspnea and cough with worsening purulent sputum production. He is currently using
inhaled albuterol as needed. In addition to systemic corticosteroids, what pharmacologic
agent is warranted at this time for treatment of this patient?
Empiric antibiotic treatment (indicated in the treatment of acute exacerbations of COPD if there
are sputum changes suggestive of bacterial infection, such as increased quantity and purulence.)
Management of COPD Exacerbations
Short acting bronchodilators
Antibiotics (macrolide/tetracycline)
Oral Steroids
A 67 year-old man presents complaining of gradually worsening fatigue and shortness of
breath. He is a previous smoker with an 80 pack-year smoking history. He denies chest
pain, night sweats, or hemoptysis. On physical examination, you note a very thin male who
appears older than his stated age. Lung and heart sounds are barely audible to
auscultation. What intervention is likely to alter the disease course (Reduce mortality)?
Home oxygen therapy (has been shown to prolong life in patients with COPD and alter the
natural history of the disease.)
, Long-term oxygen therapy is recommended for patients with a partial pressure of oxygen
in arterial blood < ______ mm Hg or oxygen saturation <______%
55, 90
A 57-year-old man is being evaluated for shortness of breath. The following spirometric
data are obtained: VC 4.90 L (predicted), 5.15 L (observed) 105% predicted FRC 3.99 L
(predicted), 4.37 L (observed) 110% predicted RV 2.47 L (predicted), 3.17 L (observed)
128% predicted FEV1 3.50 L (predicted), 2.35 L (observed) 67% predicted. These findings
are consistent with what type of disease?
obstructive lung disease (typically show normal or increased total lung capacity, decreased vital
capacity, prolonged FEV1, and increased residual volume.)
Airflow limitation that is irreversible or only partially reversible with bronchodilator is the
characteristic physiologic feature of
COPD
Chest radiographs demonstrate increased interstitial markings, particularly at the bases
and thickening of the bronchial walls. elevated HGB, peripheral edema.
chronic bronchitis
On physical exam, you note a thin, barrel-chested man with decreased heart and breath
sounds, pursed-lip breathing, end-expiratory wheezing, and scattered rhonchi. Chest X-ray
reveals a flattened diaphragm, hyperinflation and a small, thin appearing heart. PFTs
show a decreased FEV1 / FVC ratio.
emphysema
Complete Solutions
Mucous gland enlargement and goblet cell hyperplasia is associated with
chronic bronchitis
dyspnea, chronic cough that is productive of phlegm, 40 pack-years of smoking,
wheezes/rales on PE
chronic bronchitis
enlarged air spaces secondary to alveolar destruction
emphysema
A patient with severe COPD presents to the Emergency Department with a 3 day history of
increasing shortness of breath with exertion and cough productive of purulent sputum. An
arterial blood gas reveals a pH of 7.25, PaCO2 of 70 mmHg and PaO2 of 50 mmHg. He is
started on albuterol nebulizer, nasal oxygen at 2 liters per minute, and an IV is started.
After one hour of treatment, his arterial blood gas now reveals a pH of 7.15, PaCO2 100
mmHg and PaO2 of 70 mmHg. What is the most appropriate next step in his treatment?
This person has increasing respiratory failure as indicated by the raising PaCO2 levels.
Intubation is required at this time.
A 73-year-old obese female with a 20 pack year smoking history presents complaining of
chronic productive cough. She states that it has been occurring over the past 3 years more
frequently November through February. What pulmonary function test values would you
expect to find decreased?
,FEV1/FVC
A 75 year-old man with a long history of COPD presents with acute onset of worsening
dyspnea, increased productive cough, and marked agitation. While in the emergency
department he becomes lethargic and obtunded. His ABG's reveal a PaO2 40 mmHg,
PaCO2 65 mmHg, and arterial pH 7.25. Which of the following is the most appropriate
management at this point?
This patient is in severe respiratory arrest with markedly impaired mental status; endotracheal
intubation and mechanical ventilation is required.
In patients with COPD, what has been shown to decrease rate of malignancy and
cardiovascular disease and improve survival?
smoking cessation
A 45 year-old male presents with complaints of a chronic cough productive of
mucopurulent sputum. The cough has been present for the past 3 years, but he attributed it
to a "smoker's cough". He has been coughing up a lot of sputum lasting all winter long for
the past 2 years. He denies any hemoptysis, weight loss or chest pain. Physical examination
reveals a moderately obese male in no acute respiratory distress. Lung fields reveal
presence of scattered rhonchi and wheezes. There is 1+ peripheral edema. What is the most
likely diagnosis?
Chronic bronchitis
A 56 year-old male with a 40 pack-year smoking history presents complaining of
progressive shortness of breath. Spirometry reveals an FEV1 of 2 L (40% of predicted), an
,FVC of 4 L (80% of predicted) and an FEV1/FVC of 50%. These findings are most
consistent with
chronic bronchitis
A 55 year-old man with a history of chronic bronchitis presents with two days of increased
dyspnea and cough with worsening purulent sputum production. He is currently using
inhaled albuterol as needed. In addition to systemic corticosteroids, what pharmacologic
agent is warranted at this time for treatment of this patient?
Empiric antibiotic treatment (indicated in the treatment of acute exacerbations of COPD if there
are sputum changes suggestive of bacterial infection, such as increased quantity and purulence.)
Management of COPD Exacerbations
Short acting bronchodilators
Antibiotics (macrolide/tetracycline)
Oral Steroids
A 67 year-old man presents complaining of gradually worsening fatigue and shortness of
breath. He is a previous smoker with an 80 pack-year smoking history. He denies chest
pain, night sweats, or hemoptysis. On physical examination, you note a very thin male who
appears older than his stated age. Lung and heart sounds are barely audible to
auscultation. What intervention is likely to alter the disease course (Reduce mortality)?
Home oxygen therapy (has been shown to prolong life in patients with COPD and alter the
natural history of the disease.)
, Long-term oxygen therapy is recommended for patients with a partial pressure of oxygen
in arterial blood < ______ mm Hg or oxygen saturation <______%
55, 90
A 57-year-old man is being evaluated for shortness of breath. The following spirometric
data are obtained: VC 4.90 L (predicted), 5.15 L (observed) 105% predicted FRC 3.99 L
(predicted), 4.37 L (observed) 110% predicted RV 2.47 L (predicted), 3.17 L (observed)
128% predicted FEV1 3.50 L (predicted), 2.35 L (observed) 67% predicted. These findings
are consistent with what type of disease?
obstructive lung disease (typically show normal or increased total lung capacity, decreased vital
capacity, prolonged FEV1, and increased residual volume.)
Airflow limitation that is irreversible or only partially reversible with bronchodilator is the
characteristic physiologic feature of
COPD
Chest radiographs demonstrate increased interstitial markings, particularly at the bases
and thickening of the bronchial walls. elevated HGB, peripheral edema.
chronic bronchitis
On physical exam, you note a thin, barrel-chested man with decreased heart and breath
sounds, pursed-lip breathing, end-expiratory wheezing, and scattered rhonchi. Chest X-ray
reveals a flattened diaphragm, hyperinflation and a small, thin appearing heart. PFTs
show a decreased FEV1 / FVC ratio.
emphysema
