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Old 09-23-2012
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Arrow Gyrus Daily Questions; Internal Medicine #21

A 63-year-old male with a long history of cigarette smoking comes to see you for a 4-month history of progressive shortness of breath and dyspnea on exertion. The symptoms have been indolent, with no recent worsening. He denies fever, chest pain, or hemoptysis. He has a daily cough of 3 to 6 tablespoons of yellow phlegm. The patient says he has not seen a physician for over 10 years. Physical examination is notable for normal vital signs, a prolonged expiratory phase, scattered rhonchi, elevated jugular venous pulsation, and moderate pedal edema. Hematocrit is 49%. Which of the following therapies is most likely to prolong his survival?

A. Atenolol
B. Enalapril
C. Oxygen
D. Prednisone
E. Theophylline
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Old 09-23-2012
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Answer C Oxygen

His hematocrit is high ,indicates polycythemia secondary to hypoxia which indicates COPD.

Moreover elevated JVP indicates cor pulmonale due to pulmonary hypertension.

Indications for home use O2 -1. SaO2 <88% 2.PaO2<55 3.Polycythemia 4.pulmonary hypertension
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Old 09-23-2012
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Correct..

The answer is C.
The only therapy that has been proved to improve survival in patients with COPD is oxygen in the subset of patients with resting hypoxemia. This patient probably has resting hypoxemia resulting from the presence of an elevated jugular venous pulse, pedal edema, and an elevated hematocrit. Theophylline has been shown to increase exercise tolerance in patients with COPD through a mechanism other than bronchodilation. Glucocorticoids are not indicated in the absence of an acute exacerbation and may lead to complications if they are used indiscriminately. Atenolol and enalapril have no specific role in therapy for COPD but are often used when there is concomitant illness.
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C. Oxygen...................Home Oxygen Therapy

Just to add, smoking cessation is the only other factor known to prolong survival.
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