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1. What test is considered the simplest method to most accurately determine the presence of COPD? A. Chest X-Ray B. Spiral computer tomography (CT) c. Brain natriuretic peptide (BNP) D. Office Spirometry 2. Based upon the results of the spirometry (FEV1), you diagnose the following condition: A. Mild COPD B. Moderate COPD c. Severe COPD D. Very Severe COPD 3. Which result of the spirometry provided you the information necessary to diagnose restrictive lung disease? AFVC B. PEF c. FEV /FVC D. FEF 25-75 SW is a 72 year old female who presents with shortness of breath on exertion and worsening fatigue for the last few months. She does not complain of chest pain or tightness. She has noted slight bilateral foot and ankle swelling worse over past several months. In terms of past medical history, she has smoked half a pack per day for the past 50 years and is unwilling to quit. She has been previously diagnosed with breast cancer that was treated with lumpectomy and local radiotherapy. During an emergency room visit last year for an episode of shortness of breath, she was prescribed an albuterol inhaler She has been treated for hypertension for the past 23 years (current medications: propranolol 80 mg twice daily and hydrochlorothiazide 25 mg daily) On physical examination, her vital signs are as follows: Heart rate 60 bpm, Respiratory rate 30 bpm, and blood pressure 152/85 mmHg. Examination of her lungs revealed an expanded chest with tympanitic, distant breath sounds and faint wheezes diffusely. Heart sounds were normal. . For this patient, the differential diagnosis includes COPD, asthma, heart failure, pulmonary embolism, pneumothorax and medication induced cough. Spirometry is performed and the following values are obtained: Pre Broncodilator Measured % Post Broncodilator Measured * * change Predicte d 2.66 2.02 76 1.32 0.54 41 50 26 -35 1.26 0.50 39 47 25 -37 -6 -2 FVC FEV1 FEV1/FV C PEF FEF 25 FEF 50 FEF 75 FEF 25-75 315 4.96 2.85 0.78 1.82 114 0.40 0.20 0.10 0.19 5 -28 36 8 7 13 10 120 0.30 0.20 38 6 7 . 198 -6 0.18 10
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