MKSAP: 58-year-old man with idiopathic pulmonary fibrosis (IPF)

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 58-year-old man is evaluated in follow-up for idiopathic pulmonary fibrosis (IPF), which was diagnosed 2 years ago. He has cough and shortness of breath and now requires supplemental oxygen at rest. Previous evaluations have not identified any cause for his symptoms other than progressive IPF. He has participated in pulmonary rehabilitation and continues in a maintenance program. He is a lifelong nonsmoker. His medical history is otherwise unremarkable, and he takes no medications. On physical examination, the patient is afebrile, blood pressure is normal, pulse rate is 96/min, and respiration rate is 26/min; BMI is 27. Oxygen saturation is 92% breathing 4 L of oxygen by nasal cannula. Pulmonary examination reveals inspiratory crackles at the bases bilaterally. Results of a 6-minute walk test are 335 meters (1100 feet) (declined from 457 meters [1500 feet] 6 months ago). Which of the following is the most appropriate management? A. Azathioprine B. Daily prednisone C. Etanercept D. Lung transplantation Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Pulmonology Source Type: blogs