NBME Step 2 CK Form 8 Chronic obstructive pulmonary disease (NBME Answers)

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submitted by ∗step_prep(148)

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Middle aged patient with significant smoking history who is breathing with pursed lips (“pink puffer” of emphysema) and has diffuse wheezes in all lung fields, concerning for COPD
Aspiration of foreign body would only be acute, asthma would be episodic (not chronic progressive), bronchiectasis would be less likely to lead to diffuse lung changes and heart failure would lead to S4, elevated JVP, significant lower extremity edema, etc.

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merpaperple "bronchiectasis would be less likely to lead to diffuse lung changes" - idk about that? You can't even really tell what lung changes there are here without any kind of imaging, and bronchiectasis can also present with wheezing on exam. I picked bronchiectasis but I think looking back the tells were the history of smoking and the "pink puffer" appearance (maybe A1AT given her age), vs in bronchiectasis they would more likely give you some predisposing factor (eg CF, recurrent infection), as well as probably more than one tablespoon of sputum production per day and possibly hemoptysis. +4