QuestionSBA
QuestionChoice
Whilst lung cancer is an important differential to consider, the absence of weight loss and haemoptysis is reassuring. Furthermore, lung cancer would be expected to show a mass or effusion on chest x-ray. The absence of these features makes COPD a more likely underlying diagnosis.
10025926
b
Lung cancer
QuestionChoice
Whilst lung cancer is an important differential to consider, the absence of weight loss and haemoptysis is reassuring. Furthermore, lung cancer would be expected to show a mass or effusion on chest x-ray. The absence of these features makes COPD a more likely underlying diagnosis.
10025928
d
Asthma
QuestionChoice
This is incorrect. Whilst a lower respiratory tract infection or pneumonia can present with a productive cough and shortness of breath, the chronic duration of these symptoms and the absence of a temperature make COPD a more likely underlying diagnosis. This is also supported by the chest x-ray and spirometry findings.
10025929
e
Pneumonia
QuestionChoice
This is incorrect. Interstitial lung disease shows a restrictive pattern on spirometry. FEV1 and FVC are equally reduced, resulting in a preserved FEV1/FVC. Given the reduced FEV1/FVC ratio seen in this case, an obstructive lung disease such as COPD is a more likely underlying explanation.
10025927
c
Interstitial lung disease
QuestionChoice
This is correct. COPD typically presents as chronic breathlessness and cough in an elderly patient with a significant smoking history. The examination finding of bilateral expiratory wheeze is also typical of COPD, while the hyper-resonant percussion note is due to 'barrel chest' or lung hyperinflation which is also seen on x-ray.
 

 COPD also shows an obstructive pattern of disease on spirometry which is an FEV1/FVC ratio of less than 0.7, as seen in this case.
10025925
a
Chronic obstructive pulmonary disease (COPD)
Concept
Chapter
2693
3717
Chronic obstructive pulmonary disease (COPD)
Topic
132
Respiratory
Chronic obstructive pulmonary disease (COPD)
17583
A 70-year-old woman presents with a chronic productive cough, breathlessness, and recurrent chest infections over the past year. She denies haemoptysis or weight loss but experiences shortness of breath when walking upstairs, though she can walk comfortably on flat surfaces. She does not drink alcohol but has smoked one packet of cigarettes a day for the last 55 years.

On examination, there is a bilateral expiratory wheeze, hyper-resonance on percussion throughout the lung fields, and a mildly elevated respiratory rate of 22 breaths per minute, with otherwise normal observations.

A chest x-ray shows hyperinflation of the chest with no masses, effusions or lymphadenopathy. Spirometry shows a reduced FEV1/FVC ratio of 0.6.


Which of the following is the most likely underlying diagnosis?
a