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Old 12-15-2012
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Arrow A 53-year-old man with SOB

A 53-year-old man presents to the clinic with complaints of increasing shortness of breath, a nagging cough, and weight loss over several months. He reports no history of cigarette smoking but has worked underground in the New York City subway system for the past 20 years. Spirometry tests are ordered that demonstrate a forced expiratory volume in 1 second:forced vital capacity ratio (FEV1:FVC) of 0.7, and an FEV1 value that is 60% of expected. The FEV1 improves to 70% of expected with bronchodilator treatment. Which of the following is the most likely diagnosis?

(A) Asthma
(B) Chronic aspiration
(C) Chronic obstructive pulmonary disease
(D) Histoplasmosis
(E) Tuberculosis

Ans A or C
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Old 12-15-2012
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(A) Asthma

As improvement occurs with use of bronchodilator.
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Old 12-16-2012
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It's A) as because it's reversibility of FEV1 with bronchodilator use....whereas COPD is always irreversible.
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Old 12-16-2012
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Default (A) Asthma

(A) Asthma
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Old 12-16-2012
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i think its C.......
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Old 12-17-2012
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I am also picked asthma but the correct answer is C. This manís age, symptoms, and history suggest a diagnosis of chronic obstructive pulmonary disease (COPD). The diagnosis is supported by a decreased forced expiratory volume in 1 second:forced vital capacity ratio (FEV1:FVC) of 0.7 and a FEV1 value that is 60% of expected. Although the obstructed airways are not completely reversible ((In MTB2 page 134 under the head of Diagnostic test: COPD associated with incomplete improvement with albuterol)), which differentiates it from asthma.
In asthma the airway constriction, however, is largely reversible with bronchodilator treatment.In MTB2 page 131 The FEV1 improves to >12% of expected with bronchodilator treatment so in this pt should be at least 72%.
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Old 12-18-2012
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Very interesting question.Keep it up
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