03-08-2008, 12:04 PM
A 67-year-old man with longstanding chronic obstructive pulmonary disease (COPD) is hospitalized with a 1-week history of increasing cough productive of large amounts of purulent sputum, low-grade fever, lethargy, and shortness of breath.
On physical examination, his vital signs are normal except for a temperature of 38.2 °C (100.7 °F) and a pulse rate of 108/min. The neck veins are not distended. The anterior“posterior chest dimension is increased and is hyperresonant to percussion, breath sounds are reduced, and expiration is prolonged.
Arterial blood gases are normal except for a PO2 of 62 mm Hg with the patient breathing 28% oxygen through a venturi mask. Chest radiography shows changes compatible with COPD but no acute process.
In the emergency department, treatment with inhaled bronchodilators and antibiotics was begun.
Which of the following options is the best choice?
( A ) Add inhaled fluticasone, every 12 hours
( B ) Add methylprednisolone, 500 mg intravenously once
( C ) Add methylprednisolone, 125 mg intravenously every 6 hours for 3 days, then taper over 2 weeks
( D ) Add methylprednisolone, 125 mg intravenously every 6 hours for 3 days, then taper over 8 weeks
On physical examination, his vital signs are normal except for a temperature of 38.2 °C (100.7 °F) and a pulse rate of 108/min. The neck veins are not distended. The anterior“posterior chest dimension is increased and is hyperresonant to percussion, breath sounds are reduced, and expiration is prolonged.
Arterial blood gases are normal except for a PO2 of 62 mm Hg with the patient breathing 28% oxygen through a venturi mask. Chest radiography shows changes compatible with COPD but no acute process.
In the emergency department, treatment with inhaled bronchodilators and antibiotics was begun.
Which of the following options is the best choice?
( A ) Add inhaled fluticasone, every 12 hours
( B ) Add methylprednisolone, 500 mg intravenously once
( C ) Add methylprednisolone, 125 mg intravenously every 6 hours for 3 days, then taper over 2 weeks
( D ) Add methylprednisolone, 125 mg intravenously every 6 hours for 3 days, then taper over 8 weeks