A 60-Year-Old Man with a History of Chronic Obstructive Pulmonary

question 817

Multiple Choice

A 60-year-old man with a history of chronic obstructive pulmonary disease comes to the office due to hemoptysis.  For the past several days, he has had increasing cough with greenish-yellow sputum.  He also had 2 episodes of blood-streaked sputum, which prompted the clinic visit.  The patient has mild dyspnea but no fever or chest pain.  His other medical problems are peripheral vascular disease and osteoarthritis.  His current medications include aspirin, inhaled fluticasone and salmeterol, and ipratropium.  He continues to smoke 1/2 pack of cigarettes daily and drinks alcohol occasionally.  The patient had a screening CT scan 2 years ago that was negative for lung mass.  His father died of lung cancer.  Blood pressure is 140/95 mm Hg and heart rate is 100/min.  The patient's pulse oximetry shows 95% on room air.  Lung auscultation reveals bilateral expiratory wheezing. The initial workup reveals no significant abnormality.  The patient is started on glucocorticoid therapy and additional inhaled albuterol.  Which of the following is the best next step in management?

• A)Hospital admission
• B)Inhaled N-acetylcysteine
• C)No additional intervention
• D)Oral antibiotics
• E)Oral theophylline

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Definitions:

Underwood Tariff

A 1913 U.S. law that significantly lowered tariffs on imported goods for the first time since the Civil War and implemented an income tax following the ratification of the 16th Amendment.

Tariff Rates

Taxes imposed by a government on imported or exported goods.

Independent Commission

An autonomous body established to investigate, analyze, or oversee specific issues or areas, often governmental or industry-related, without bias.

Theodore Roosevelt

The 26th President of the United States, known for his progressive policies, leadership in the early 20th century, and role in mediating the end of the Russo-Japanese War.