08-11-2016, 02:01 PM
NBME Q
A 52-year-old Hispanic man is admitted to the hospital because of severe dyspnea and cough productive of tenacious, brownish-yellow sputum for the past 3 weeks. He has a 15-year career history of sandblasting old buildings. He has smoked two packs of cigarettes daily for the past 30 years. The patient is 168 cm (5 ft 6 in) tall and weighs 59 kg (130 lb); BMI is 21 kg/m2. Vital signs are temperature 36.8°C (98.2°F), pulse 94/min, and blood pressure 150/92 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 70%. On physical examination he is in moderately severe distress with pursed lips and cyanotic nail beds. Chest has an increased anteroposterior diameter. Auscultation of the chest discloses scattered wheezes and rhonchi over all lung fields. Cardiac examination discloses muffled heart sounds and an S4. Fingers are clubbed. Chest x-ray shows hyperinflated lungs, flattened diaphragm, large, irregular opacities in the upper lobes and eggshell calcifications of the hilar lymph nodes. Which of the following is the most accurate statement concerning the patient's long-term prognosis?
A) He is likely to avoid the complications of pulmonary hypertension if treated aggressively
B) He is likely to develop carcinoma of the lung within 5 years
C) He is likely to maintain his current respiratory status if he stops smoking now
D) His condition is likely to progressively worsen regardless of therapy
E) His respiratory function is likely to improve markedly if he stops smoking now
A 52-year-old Hispanic man is admitted to the hospital because of severe dyspnea and cough productive of tenacious, brownish-yellow sputum for the past 3 weeks. He has a 15-year career history of sandblasting old buildings. He has smoked two packs of cigarettes daily for the past 30 years. The patient is 168 cm (5 ft 6 in) tall and weighs 59 kg (130 lb); BMI is 21 kg/m2. Vital signs are temperature 36.8°C (98.2°F), pulse 94/min, and blood pressure 150/92 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 70%. On physical examination he is in moderately severe distress with pursed lips and cyanotic nail beds. Chest has an increased anteroposterior diameter. Auscultation of the chest discloses scattered wheezes and rhonchi over all lung fields. Cardiac examination discloses muffled heart sounds and an S4. Fingers are clubbed. Chest x-ray shows hyperinflated lungs, flattened diaphragm, large, irregular opacities in the upper lobes and eggshell calcifications of the hilar lymph nodes. Which of the following is the most accurate statement concerning the patient's long-term prognosis?
A) He is likely to avoid the complications of pulmonary hypertension if treated aggressively
B) He is likely to develop carcinoma of the lung within 5 years
C) He is likely to maintain his current respiratory status if he stops smoking now
D) His condition is likely to progressively worsen regardless of therapy
E) His respiratory function is likely to improve markedly if he stops smoking now