04-12-2007, 06:10 PM
6. A 52-year-old African-American man returns to the health center for a follow-up visit 1 week after he was discharged from the hospital after being diagnosed with acute pneumonia. Discharge medications included inhaled bronchodilators, oral antibiotics and a tapering course of oral corticosteroids. The antibiotic and corticosteroid therapies were completed yesterday. He has no previous hospital admissions for respiratory disease. He has a nonproductive, chronic, daily cough. He smoked one to two packs of cigarettes per day since age 13 years, but he has not smoked since admission to the hospital. Vital signs today are: temperature 36.8°C (98.2°F), pulse 92/min, respirations 10/min and blood pressure 120/80 mm Hg. On physical examination he appears well. There are markedly diminished, but clear, breath sounds with no wheezing or rhonchi; there is a prolonged expiratory phase. There is no digital clubbing. Which of the following is the most likeley diagnosis?
A
) Asthma
B
) Bronchiectasis
C
) Chronic bronchitis
D
) Emphysema
E
) Pulmonary fibrosis
A
) Asthma
B
) Bronchiectasis
C
) Chronic bronchitis
D
) Emphysema
E
) Pulmonary fibrosis