Which long-term resident is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)?

A 79 year old lifetime smoker who is complaining of shortness of breath and pain on deep inspiration

An 88 year old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke

An 81 year old smoker who has increased exercise intolerance, a fever and increased white blood cells

An 81 year old male who has a productive cough and recurrent respiratory infections

Answer and Explanation

The Correct Answer is A

A. A 79-year-old lifetime smoker who is complaining of shortness of breath and pain on deep inspiration: Chronic obstructive pulmonary disease (COPD) is most commonly seen in individuals with a significant smoking history. Progressive shortness of breath is a hallmark symptom of COPD, resulting from chronic airway inflammation and airflow limitation. While pain on deep inspiration is not a classic COPD symptom, it could indicate pleuritic involvement or hyperinflation-related chest discomfort.

B. An 88-year-old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke: Acute shortness of breath and airway constriction in response to tobacco smoke suggests an asthma-like reaction rather than COPD. COPD symptoms tend to be persistent and progressive rather than episodic.

C. An 81-year-old smoker who has increased exercise intolerance, a fever, and increased white blood cells: Fever and increased white blood cells indicate an acute infection rather than chronic lung disease. While COPD exacerbations can cause worsening symptoms, an isolated fever and elevated white blood cells suggest pneumonia or another infectious process rather than COPD alone.

D. An 81-year-old male who has a productive cough and recurrent respiratory infections: A productive cough and recurrent respiratory infections are common in chronic bronchitis, a component of COPD. However, this presentation alone is not specific to COPD, as other conditions, such as bronchiectasis, can also cause these symptoms.

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Correct Answer is A

Explanation

A. Controlling the blood pressure: Controlling blood pressure is crucial for reducing the risk of developing coronary artery disease (CAD). Even with a normal lipid panel, hypertension can significantly contribute to cardiovascular risk, and managing blood pressure helps protect against the development of CAD.

B. Moderate alcohol use: While moderate alcohol consumption may have some potential benefits for heart health, it is not a primary risk factor reduction strategy. The focus should be on more impactful lifestyle changes, particularly for individuals with normal lipid levels.

C. Eating a low-fat diet: Although a balanced diet is important for overall health, a low-fat diet specifically is not necessary for everyone, especially those with normal lipid levels. The emphasis should be on a heart-healthy diet that includes healthy fats, such as those from fish, nuts, and olive oil, rather than simply reducing fat intake.

D. Avoiding air pollution: Avoiding air pollution can have health benefits, but it is not a primary strategy for individuals seeking to reduce the risk of CAD. Addressing more direct risk factors, such as blood pressure management, is more critical in this context.

A. Administration of broad spectrum antibiotics B. Administration of drugs that decrease airway inflammation C. Avoidance of the causative agent D. Administration of drugs that reduce bronchospasm

Correct Answer is C

Explanation

A. Administration of broad-spectrum antibiotics: Broad-spectrum antibiotics are not a primary treatment for asthma, as asthma is an inflammatory condition and not primarily caused by bacterial infections. Antibiotics may be used for coexisting infections but are not the most successful initial treatment for chronic asthma.

B. Administration of drugs that decrease airway inflammation: While decreasing airway inflammation is important in managing asthma, the most successful long-term treatment begins with addressing the underlying causes and triggers. Reducing inflammation is part of the treatment strategy but is not the first action.

C. Avoidance of the causative agent: Avoiding the causative agent or trigger of asthma is the most successful initial treatment. Identifying and eliminating exposure to allergens or irritants, such as pollen, smoke, or pet dander, can significantly reduce the frequency and severity of asthma attacks, making it the foundational step in asthma management.

D. Administration of drugs that reduce bronchospasm: Medications that reduce bronchospasm, such as bronchodilators, are essential for immediate relief of asthma symptoms. However, they do not address the underlying inflammation and triggers, making avoidance of causative agents the most successful initial treatment for chronic asthma.

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Which long-term resident is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)?

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