10-29-2011, 05:25 PM
n4b1q11
11. A 42-year-old woman comes to the physician because of progressive shortness of breath during the past 6 months. She now has to rest three or four times when climbing one flight of stairs. She has smoked one pack of cigarettes daily for 26 years. She has a chronic nonproductive cough and has wheezing controlled with an albuterol inhaler two to three times weekly. During the past year, her BMI has increased from 45 kg/m2 to 52 kg/m2. Her temperature is 37°C (98.6°F), pulse is 95/min, respirations are 24/min and shallow, and blood pressure is 140/90 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The abdomen is distended. There is 1+ edema of the ankles. Arterial blood gas analysis on room air shows:
pH 7.37
Pco2 48 mm Hg
Po2 62 mm Hg
O2 saturation 92%
Her FEV1 is 75% of predicted, and total lung capacity is 50% of predicted. Which of the following is the most likely diagnosis?
A) Chronic obstructive pulmonary disease
B) Congestive heart failure
C) Interstitial pneumonia
D) Recurrent pulmonary embolism
E) Restrictive lung disease
11. A 42-year-old woman comes to the physician because of progressive shortness of breath during the past 6 months. She now has to rest three or four times when climbing one flight of stairs. She has smoked one pack of cigarettes daily for 26 years. She has a chronic nonproductive cough and has wheezing controlled with an albuterol inhaler two to three times weekly. During the past year, her BMI has increased from 45 kg/m2 to 52 kg/m2. Her temperature is 37°C (98.6°F), pulse is 95/min, respirations are 24/min and shallow, and blood pressure is 140/90 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The abdomen is distended. There is 1+ edema of the ankles. Arterial blood gas analysis on room air shows:
pH 7.37
Pco2 48 mm Hg
Po2 62 mm Hg
O2 saturation 92%
Her FEV1 is 75% of predicted, and total lung capacity is 50% of predicted. Which of the following is the most likely diagnosis?
A) Chronic obstructive pulmonary disease
B) Congestive heart failure
C) Interstitial pneumonia
D) Recurrent pulmonary embolism
E) Restrictive lung disease