Question

A 62 year old woman with COPD presents to her physician complaining of two days of increasing dyspnea and cough. She uses supplemental oxygen at home and has had to increase her oxygen flow to relieve her shortness of breath. Recently, her cough has been productive of copious amounts of thick, dark yellow sputum. Although she never checked her temperature at home, she thinks she might have had a fever last night. Past medical history includes hypertension and peripheral arterial disease. She has smoked 1 1/2 -2 packs of cigarettes per day for the last 45 years and continues to smoke. Current medications include nebulized albuterol, tiotropium, inhaled fluticasone/salmeterol, lisinopril, and pentoxyfylline. Physical examination reveals an uncomfortable, thin female appearing older than her stated age. Vital signs are: temperature 37.2 C (99.0 F), pulse 80, blood pressure 136/70, respirations 20/min, oxygen saturation 88% on 2 L O2 by nasal cannula. The patient is using accessory muscles to breathe, and prolonged expirations and faint expiratory wheezes throughout the lung fields. Coarse crackles are heard at the lung bases. The patient's chest X-ray is shown. Which of the following is the most appropriate

treatment for this patient?
A. Methylprednisolone
B. Prednisone and amoxicillin
C. Guaifenasin
D. Trimethoprim/sulfamethoxazole
E. Aminophylline

Answer 1

For a 62-year-old woman with COPD exacerbation and signs of bacterial infection, the most appropriate treatment is a combination of systemic corticosteroids and antibiotics, specifically prednisone and amoxicillin.

Step-by-step explanation:

The patient, a 62-year-old woman with chronic obstructive pulmonary disease (COPD), is presenting with increasing dyspnea, cough, and production of thick, dark yellow sputum, possibly indicative of a bacterial infection superimposed on COPD. Considering her clinical presentation, use of accessory muscles, and auscultatory findings of both wheezes and crackles, it is likely that she is experiencing an acute exacerbation of COPD complicated by bacterial pneumonia. The most appropriate treatment would be a combination of systemic corticosteroids and antibiotics to address both the inflammation and the suspected bacterial infection.

The correct answer from the options provided is B. Prednisone and amoxicillin. Prednisone will help to reduce the inflammation associated with the COPD exacerbation, while amoxicillin is used to cover common bacterial pathogens that can cause pneumonia. This combination therapy is commonly used in the management of COPD exacerbations with signs of bacterial infection.