A 64-year-old man with moderate COPD (40 pack-years) has 3 days of breathlessness, wheeze and productive cough. No chest pain or fever. RR 24, HR 100, BP 130/76, SpO₂ 90%. He is conscious and speaks full sentences. ABG: pH 7.36, PCO₂ 50, PaO₂ 64, HCO₃ 26. He received nebulised bronchodilators and oxygen. What should be added?
سؤال مجاني 4 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: B. Systemic corticosteroid
This is an AECOPD without acidosis (pH 7.36), so NIV is not indicated (needs PaCO2 at least 45 and pH 7.35 or lower), and intubation is a last resort. After bronchodilators and oxygen, add systemic glucocorticoids (prednisone PO / methylprednisolone), which improve FEV1 and oxygenation and shorten recovery. No volume overload, so no diuretic.
ليش كل خيار صح أو غلط
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A
ليش غلط
NIPPV is indicated for respiratory acidosis (PaCO2 ≥ 45 and pH ≤ 7.35). His pH is 7.36, so this criterion is not met, and he is conscious and speaking full sentences.
✓ COPD.pdf · p. 11 -
B
ليش صح
After bronchodilators and oxygen, systemic glucocorticoids (prednisone PO or methylprednisolone) improve FEV1 and oxygenation and shorten recovery and hospital stay.
✓ COPD.pdf · p. 12 -
C
ليش غلط
Intubation is high-risk in AECOPD and is a last resort, for when NIPPV fails or in life-threatening hypoxemia. This patient is stable and speaking full sentences.
✓ COPD.pdf · p. 12 -
D
ليش غلط
AECOPD pharmacotherapy is inhaled bronchodilators, systemic glucocorticoids and antibiotics when indicated; a diuretic is not part of it, and nothing in the case suggests volume overload.
✓ COPD.pdf · p. 12
- المصدر
- COPD.pdf · p. 11
COPD.pdf · p. 12 - المحاضرة
- COPD Exacerbation · Pulmonology · Module B
- ظهر في
- MED42 Compre B