cases on chronic obstructive diseases, Essays (university) of Pathology

Download cases on chronic obstructive diseases and more Essays (university) Pathology in PDF only on Docsity! Case Study Number One • A 38 year old female amateur astronomer, all the while knowing better, has smoked since she was 18 years old. She has been having trouble for years with the smoke and the light of the cigarette impairing her ability to see the more distant galaxies through her telescope, but she has not been willing to quit yet. • Additionally, she has noticed a mild, occasionally productive cough for the past 3-4 months. The cough is worse whenever she spends the night out in the country taking astrophotos where she is exposed to the smoke of the nearby wild fires. • She finally decides to visit her family physician who, after making appropriate patient-centered inquiries as to how her astrophotography hobby is going, finds that she has been smoking about one pack per day for the past 20 years. • The cough has been present for almost a year. She has had no fever or chills. She does admit to more shortness of breath when she exercises over the past six months. • Her only other past medical history includes hypertension for which she is using lisinopril, metoprolol, and hydrochlorothiazide. At this point, what further investigations do you think would be appropriate? A. Chest radiograph (CXR) B. Computed axial tomography (CT) of the chest C. Complete blood count (CBC) and thyroid stimulating hormone (TSH) level D. Spirometry E. A and D • You perform a physical exam and obtain a CXR in the office; the findings are normal. You had the foresight to obtain a spirometry machine for your family medicine clinic, and the post-bronchodilator study demonstrates the following: – FEV1: 85% of predicted – FEV1/FVC: 65% How would you interpret these findings in light of her clinical picture? A. Normal B. Moderate COPD C. Restrictive lung disease D. Mild COPD E. Mild Asthma Case Study Number One • You make the diagnosis of early mild COPD and wish to begin a discussion with your pleasant astronomer patient about management. Which one of the following would be the best option to improve her symptoms and slow progression? A. Begin inhaled medications to treat her pulmonary symptoms. B. Begin counseling about the importance of tobacco cessation. C. Offer to buy her a new telescope. D. Begin counseling and start varenicline at this visit. • She agrees to start varenicline. You also must consider whether she should change any of her other medications. What would you do? A. Continue all medications unchanged. B. Discontinue the beta blocker because she has COPD. C. Stop the angiotensin converting enzyme (ACE) inhibitor because this may be the cause of her cough. D. Hold her diuretic because she is often so far out in the country looking at stars that she fails to empty her bladder as often as she should and may develop an overactive bladder. • After four weeks she returns to your office and has decreased her smoking to about 10 cigarettes per day. She thinks you are a fantastic doctor but she is still short of breath at the gym and is now really motivated to quit. • She asks if there is anything else that can be done to help her. Of the following, which would be the wrong decision for you to make? A. Encourage her to enroll in the tobacco cessation group counseling program at your clinic. B. Begin a short acting inhaled beta agonist to be used as needed. C. Start nicotine replacement therapy in addition to the varenicline. D. Refer her to a quit line for further assistance.