Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Test your medicine knowledge: 72-year-old woman with COPD

mksap
Conditions
June 27, 2015
Share
Tweet
Share

shutterstock_248807428

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 72-year-old woman is evaluated during a routine examination. She has very severe COPD with multiple exacerbations. She has dyspnea at all times with decreased exercise capacity. She does not have cough or any change in baseline sputum production. She is adherent to her medication regimen, and she completed pulmonary rehabilitation 1 year ago. She quit smoking 1 year ago. Her medications are a budesonide/formoterol inhaler, tiotropium, and an albuterol inhaler as needed.

On physical examination, pulse rate is 94/min, and respiration rate is 26/min. Pulmonary examination reveals distant breath sounds and no wheezing. Oxygen saturation is 86% breathing ambient air. Pulmonary function testing reveals an FEV1 of 26% of predicted and an FEV1/FVC ratio of 41%.

Which of the following is the most appropriate next step in management?

A: Oral antibiotics
B: Oxygen therapy
C: Prednisone taper
D: Repeat pulmonary rehabilitation

MKSAP Answer and Critique

The correct answer is B: Oxygen therapy.

The most appropriate next step in management is long-term oxygen therapy (LTOT). This patient’s oxygen saturation is 86% breathing ambient air. Indications for LTOT are an arterial Po2 of less than or equal to 55 mm Hg (7.3 kPa) or an oxygen saturation of less than or equal to 88% when breathing ambient air. In patients who qualify for continuous therapy because of resting hypoxemia, duration of oxygen treatment should be greater than 15 hours per day and preferably longer. The use of long-term oxygen therapy in patients with chronic respiratory failure improves survival and has a beneficial effect on hemodynamics, hematologic characteristics, exercise capacity, mental status, general alertness, motor speed, and hand grip. Studies have shown that delivering oxygen during exercise can increase the duration of endurance and/or reduce the intensity of breathlessness at the end of exercise. The Nocturnal Oxygen Therapy Trial (NOTT) showed that continuous supplemental oxygen therapy is better than nocturnal oxygen therapy alone in enhancing survival. The role and effectiveness of supplemental oxygen are less clear in patients with pulmonary disease who have normal oxygenation at rest and desaturation with exertion or nocturnally.

There is no indication for antibiotics or prednisone because this patient has no evidence of an acute exacerbation or bronchospasm.

This patient may benefit from undergoing pulmonary rehabilitation again, because data show that repeating pulmonary rehabilitation has benefits. However, given her resting hypoxemia, the most appropriate next step in management is LTOT.

Key Point

  • In patients with COPD, indications for long-term oxygen therapy are an arterial Po2 of less than or equal to 55 mm Hg (7.3 kPa) or an oxygen saturation of less than or equal to 88%.

This content is excerpted from MKSAP 16 with permission from the American College of Physicians (ACP). Use is restricted in the same manner as that defined in the MKSAP 16 Digital license agreement. This material should never be used as a substitute for clinical judgment and does not represent an official position of ACP. All content is licensed to KevinMD.com on an “AS IS” basis without any warranty of any nature. The publisher, ACP, shall not be liable for any damage or loss of any kind arising out of or resulting from use of content, regardless of whether such liability is based in tort, contract or otherwise.

Image credit: Shutterstock.com

Prev

Nutrition tips for custodial grandparents

June 26, 2015 Kevin 0
…
Next

Patients rating doctors on Yelp: It's better to embrace it

June 27, 2015 Kevin 33
…

Tagged as: Pulmonology

Post navigation

< Previous Post
Nutrition tips for custodial grandparents
Next Post >
Patients rating doctors on Yelp: It's better to embrace it

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by mksap

  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 26-year-old man with back pain

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 36-year-old man with abdominal cramping, diarrhea, malaise, and nausea

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 52-year-old woman with osteoarthritis of the right hip

    mksap

More in Conditions

  • How the shingles vaccine could help prevent dementia

    Marc Arginteanu, MD
  • Why removing fluoride from water is a public health disaster

    Steven J. Katz, DDS
  • What the research really says about infrared saunas

    Khushali Jhaveri, MD
  • How the cycle of rage is affecting physicians—and how to break free

    Alexandra M.P. Brito, MD and Jennifer L. Hartwell, MD
  • Dedicated hypermobility clinics can transform patient care

    Katharina Schwan, MPH
  • It’s time for pain protocols to catch up with the opioid crisis

    Sarah White, APRN
  • Most Popular

  • Past Week

    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • How the shingles vaccine could help prevent dementia

      Marc Arginteanu, MD | Conditions
    • How to survive a broken health care system without losing yourself [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why some doctors age gracefully—and others grow bitter

      Patrick Hudson, MD | Physician
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • What the research really says about infrared saunas

      Khushali Jhaveri, MD | Conditions
    • How the cycle of rage is affecting physicians—and how to break free

      Alexandra M.P. Brito, MD and Jennifer L. Hartwell, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • How the shingles vaccine could help prevent dementia

      Marc Arginteanu, MD | Conditions
    • How to survive a broken health care system without losing yourself [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why some doctors age gracefully—and others grow bitter

      Patrick Hudson, MD | Physician
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • What the research really says about infrared saunas

      Khushali Jhaveri, MD | Conditions
    • How the cycle of rage is affecting physicians—and how to break free

      Alexandra M.P. Brito, MD and Jennifer L. Hartwell, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...