MKSAP: 72-year-old man with dyspnea at rest

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old man is evaluated for dyspnea at rest. He has end-stage COPD and is on a home hospice program. He has weight loss, reduced functional capacity, and muscle atrophy. His medications are ipratropium, salmeterol, fluticasone, albuterol as needed, and prednisone. He is uncomfortable, with chronic air hunger that has gradually increased over the past 2 weeks. Otherwise, his symptoms have been stable without change in cough, sputum production, or fever. Following a physical exam, what is the most appropriate management? On physical examination, temperature is 37.0 °C (98.6 °F), blood pressure is 110/84 mm Hg, pulse rate is 102/min, and respiration rate is 30/min; BMI is 17. Breath sounds are decreased. Oxygen saturation on 2 L of oxygen via nasal cannula is 92%. Hematocrit is 36%. Which of the following is the most appropriate management? A: Administer a blood transfusion B: Administer diazepam C: Administer morphine sulfate D: Increase oxygen flow 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: Journals (General) Authors: Tags: Conditions Pulmonology Source Type: blogs