A 60-year-old woman presents to the clinic with a 3-month history of shortness of breath that worsens on exertion. She also complains of chronic cough that has lasted for 10 years. Her symptoms are worsened even with light activities like climbing up a flight of stairs. She denies any weight loss, lightheadedness, or fever. Her medical history is significant for hypertension, for which she takes amlodipine daily. She has a 70-pack-year history of cigarette smoking and drinks 3–4 alcoholic beverages per week. Her blood pressure today is 128/84 mm Hg. A chest X-ray shows flattening of the diaphragm bilaterally. Physical examination is notable for coarse wheezing bilaterally. Which of the following is likely to be seen with pulmonary function testing?
ADecreased FEV1: FVC and decreased total lung capacity
BNormal FEV1: FVC and decreased total lung capacity
CIncreased FEV1: FVC and decreased total lung capacity
DDecreased FEV1: FVC and increased total lung capacity
EIncreased FEV1: FVC and normal total lung capacity
A 62-year-old man presents to the emergency department for evaluation of a 2-year history of increasing shortness of breath. He also has an occasional nonproductive cough. The symptoms get worse with exertion. The medical history is significant for hypertension and he takes chlorthalidone. He is a smoker with a 40-pack-year smoking history. On physical examination, the patient is afebrile; the vital signs include: blood pressure 125/78 mm Hg, pulse 90/min, and respiratory rate 18/min. The body mass index (BMI) is 31 kg/m2. The oxygen saturation is 94% at rest on room air. A pulmonary examination reveals decreased breath sounds bilaterally, but is otherwise normal with no wheezes or crackles. The remainder of the examination is unremarkable. A chest radiograph shows hyperinflation of both lungs with mildly increased lung markings, but no focal findings. Based on this clinical presentation, which of the following is most likely?
ADecreased total lung capacity
BIncreased DLCO
CMetabolic acidosis
DFEV1/FVC of 80% with an FEV1 of 82%
EFEV1/FVC of 65%
A 50-year-old man presents to the urgent care clinic for 3 hours of worsening cough, shortness of breath, and dyspnea. He works as a long-haul truck driver, and he informs you that he recently returned to the west coast from a trip to Arkansas. His medical history is significant for gout, hypertension, hypercholesterolemia, diabetes mellitus type 2, chronic obstructive pulmonary disease (COPD), and mild intellectual disability. He currently smokes 1 pack of cigarettes/day, drinks a 6-pack of beer/day, and he endorses a past history of injection drug use but currently denies any illicit drug use. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 87/min, and respiratory rate 23/min. His physical examination shows mild, bilateral, coarse rhonchi, but otherwise clear lungs on auscultation, grade 2/6 holosystolic murmur, and a benign abdominal physical examination. He states that he ran out of his albuterol inhaler 6 days ago and has been meaning to follow-up with his primary care physician (PCP) for a refill. Complete blood count (CBC) and complete metabolic panel are within normal limits. He also has a D-dimer result within normal limits. Which of the following is the most appropriate next step in evaluation?
AChest computed tomography (CT) with contrast
BChest radiographs
CPulmonary function tests
DSputum gram stain and culture
EArterial blood gas
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