05-21-2010, 06:22 PM
A 55-year-old man is seen in your office for the first time complaining of a persistent cough. The cough began 6 months ago and occurs four to five times a week, usually during the day but occasionally these episodes awaken him from sleep. He has no other symptoms. There is no smoking history. Past medical history is significant for hypertension, diagnosed 20 years ago, and osteoarthritis of both knees. Medications are hydrochlorothiazide, lisinopril, and ibuprofen. On examination, vital signs are temperature: 32°C (89.6°F); blood pressure (BP): 120/75 mm Hg; heart rate (HR): 80 beats/min; respiratory rate (RR): 14 breaths/min. Expiratory wheezing is present bilaterally. There are no other abnormal findings.
Item 3 of 3
You have established the patient™s diagnosis and prescribed bronchodilator and steroid inhalers for long-term management. Over the ensuing 16 months, the patient develops bacterial pneumonia on three occasions. Which of the following conditions is most likely present in the patient?
End of set
A. Bronchiectasis
B. Congestive heart failure (CHF)
C. Gastroesophageal reflux (GER)
D. Isolated complete bronchial obstruction
E. Steroid-induced immunosuppression
Item 3 of 3
You have established the patient™s diagnosis and prescribed bronchodilator and steroid inhalers for long-term management. Over the ensuing 16 months, the patient develops bacterial pneumonia on three occasions. Which of the following conditions is most likely present in the patient?
End of set
A. Bronchiectasis
B. Congestive heart failure (CHF)
C. Gastroesophageal reflux (GER)
D. Isolated complete bronchial obstruction
E. Steroid-induced immunosuppression