Question

A 72-year-old man presents with an 8-month history of progressive dyspnea, which has been accompanied by a dry and persistent hacking cough. While the dyspnea now occurs at rest, he denies fever, chills, palpitations, chest pain, or peripheral edema. He states that he has worked for many years at a local chemical plant. His physical exam is remarkable for digital cyanosis and clubbing, while his pulmonary exam reveals diffuse fine, dry inspiratory crackles. His cardiac exam was positive for a prominent pulmonary valve closure sound (P2) and an elevated jugular venous pressure of 6 cm. A chest x-ray noted small lung volumes, with increased densities in the lung periphery and a honeycombing pattern; pulmonary function testing measured reductions in TLC, FEV1, and FVC with a preserved FEV1/FVC ratio.

What is the best treatment for this patient at this time?

1. Erythromycin
2. Furosemide
3. Lung transplantation
4. Prednisone
5. Cyclophosphamide

Answer 1

The best treatment for this patient is lung transplantation, as he likely has idiopathic pulmonary fibrosis.

Step-by-step explanation:

The best treatment for this patient at this time is lung transplantation. Based on the patient's symptoms and physical exam findings, as well as the chest x-ray and pulmonary function testing results, the most likely diagnosis is idiopathic pulmonary fibrosis. This is a progressive lung disease characterized by the formation of scar tissue in the lungs, leading to a reduction in lung function.

While there is no cure for idiopathic pulmonary fibrosis, lung transplantation can be a viable treatment option for some patients. It can improve lung function and quality of life for those with end-stage disease like this patient.

Erythromycin, furosemide, prednisone, and cyclophosphamide are not appropriate treatments for idiopathic pulmonary fibrosis, as they are more commonly used for other respiratory conditions or immune-related disorders.