A 67-year-old man presents to your office with worsening cough, sputum production, and shortness of breath. He has been a cigarette smoker for the past 50 years, smoking approximately 1 pack a day. He has a chronic AM cough productive of some yellow sputum but generally feels okay during the day. He was in his usual state of health until two weeks ago when he developed a cold. Since then, he has had a hacking cough and increased thick sputum production. He also has had difficulty walking more than a block without stopping due to shortness of breath. Physical examination reveals prolonged expiration, audible wheezing, and diffuse rhonchi throughout both lung fields. Chest x-ray shows hyperinflation of both lungs with a flattened diaphragm. His most likely diagnosis is:
Emphysema
Chronic Bronchitis
Small Cell Lung CA
Pulmonary Fibrosis
The Correct Answer is B
A. Emphysema: Emphysema is characterized by destruction of alveolar walls, leading to air trapping, hyperinflation, and a “pink puffer” phenotype. While the patient has hyperinflated lungs and dyspnea, the hallmark productive morning cough and increased sputum after a recent cold point more strongly toward chronic bronchitis rather than pure emphysema.
B. Chronic Bronchitis: Chronic bronchitis, a subtype of COPD, is defined by a productive cough for at least three months in two consecutive years. This patient’s long-standing daily morning sputum, exacerbation after a respiratory infection, and wheezing are classic signs. Physical exam findings (prolonged expiration, rhonchi) and hyperinflation on chest x-ray support the diagnosis of chronic bronchitis.
C. Small Cell Lung CA: Small cell lung cancer often presents with systemic symptoms such as weight loss, cough, hemoptysis, and paraneoplastic syndromes. This patient’s chronic, productive cough and COPD features are more consistent with chronic bronchitis than lung carcinoma.
D. Pulmonary Fibrosis: Pulmonary fibrosis is a restrictive lung disease characterized by progressive dyspnea, dry cough, and interstitial infiltrates on imaging. The patient’s productive cough, wheezing, and hyperinflation point toward obstructive disease rather than restrictive pathology.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Bronchial asthma:Asthma involves reversible airway obstruction due to bronchospasm and inflammation. While it can cause wheezing and shortness of breath, it does not typically result in sudden hoarseness or loss of voice.
B. Chronic bronchitis:Chronic bronchitis is a long-standing productive cough with mucus hypersecretion. It can cause throat irritation but does not usually produce acute hoarseness or aphonia.
C. Goodpasture syndrome:Goodpasture syndrome is an autoimmune disorder affecting the kidneys and lungs, causing hematuria and pulmonary hemorrhage. It does not involve the larynx or vocal cords and would not produce hoarseness or voice loss.
D. Laryngeal cancer:Laryngeal cancer, particularly in chronic smokers, commonly presents with progressive hoarseness due to involvement of the vocal cords. Tumor growth can eventually obstruct the vocal cords, leading to aphonia. These symptoms align with the patient’s history of hoarseness progressing to inability to speak.
E. Pulmonary thromboembolism:Pulmonary embolism causes sudden dyspnea, chest pain, and hypoxia, but it does not directly affect the larynx or vocal cords and would not account for hoarseness or voice loss.
Correct Answer is E
Explanation
A. Dilated cardiomyopathy:Dilated cardiomyopathy primarily causes systolic dysfunction and ventricular dilation. While it can lead to functional regurgitation due to annular dilation, it is not the classic cause of heart murmurs, which are most often due to structural valve abnormalities.
B. Hypertensive heart disease:Hypertensive heart disease leads to left ventricular hypertrophy and increased afterload. Although it can contribute to diastolic dysfunction, it does not directly produce heart murmurs unless secondary valvular changes occur.
C. Ischemic heart disease:Ischemic heart disease can cause myocardial infarction and regional wall motion abnormalities. Murmurs may develop as a secondary effect of papillary muscle dysfunction, but primary murmurs are not characteristic of ischemic heart disease.
D. Restrictive cardiomyopathy:Restrictive cardiomyopathy is characterized by impaired ventricular filling due to stiff ventricles. It may cause diastolic dysfunction but generally does not produce classic heart murmurs unless associated with secondary valvular involvement.
E. Valvular heart disease:Valvular heart disease, including stenosis or regurgitation of the mitral, aortic, tricuspid, or pulmonary valves, is the most common cause of heart murmurs. Turbulent blood flow across abnormal valves generates the audible sounds detected during auscultation, making it the primary source of murmurs in patients.
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