COPD USMLE Step 1 Practice Question
A 72-year-old man with a 50-pack-year smoking history and COPD (GOLD Stage 3, FEV1 32% predicted) presents to the emergency department with acute worsening dyspnea over 2 days. He reports increased sputum production with a yellow tint. Vital signs show respiratory rate 28/min, heart rate 105/min, blood pressure 148/92 mmHg, and O2 saturation 88% on room air. Physical examination reveals diffuse wheezing and use of accessory muscles. Chest X-ray shows hyperinflation without focal infiltrates or pneumothorax. Arterial blood gas on room air reveals pH 7.29, PaCO2 62 mmHg, PaO2 58 mmHg, and HCO3ā 30 mEq/L. The patient has a history of anxiety and requests pain control. Which of the following should be avoided in the acute management of this exacerbation?
Answer choices
- AIntravenous methylprednisolone
- BNebulized albuterol and ipratropium bromide
- CIntravenous morphine for dyspnea and anxietyCorrect answer
- DNoninvasive positive pressure ventilation (NIPPV)
- EEmpiric broad-spectrum antibiotics
- FSupplemental oxygen titrated to target SpO2 of 88-92%
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