QuestionSBA
QuestionChoice
Pulmonary oedema may cause a restrictive pattern of lung function results due to decreased lung compliance (which is not fitting with this patient's obstructive results). Also, pulmonary oedema may be caused by issues such as heart failure (which this patient shows no symptoms of, other than dyspnoea). Therefore, pulmonary oedema would be low down in this patient's differential diagnoses.
10000635
e
Pulmonary oedema
QuestionChoice
Asthma is an obstructive disease, and this patient's results show an obstructive pattern (with FEV1:FVC ratio of <70%), so this would be fitting. However, the age of this patient, and her smoking history, would make COPD the more likely diagnosis. Additionally, a five-year history would be unusual for asthma. However, we would exclude this diagnosis by testing for bronchodilator reversibility - which is present in asthma and not in COPD.
10000632
b
Asthma
QuestionChoice
Fibrotic lung disease is a restrictive disease, and so does not fit with the obstructive pattern of these results. In restrictive disease, we would also expect the TLC to be decreased, rather than increased as it is in this patient.
10000633
c
Fibrotic lung disease
QuestionChoice
In a healthy patient, the FEV1:FVC ratio should be >70%. However, the lung function results for this patient show an obstructive pattern as the FEV1:FVC ratio is <70% (1.50/2.47 = 0.60), meaning that less than 70% of the FVC is exhaled within the first second. COPD also causes hyperinflation of the lungs, which would explain this patient's increased TLC. Finally, her chronic history of dyspnoea and extensive smoking history, along with recurrent infections, fits with the clinical picture of COPD - making it the most likely diagnosis.
10000631
a
Chronic Obstructive Pulmonary Disease (COPD)
QuestionChoice
Kyphoscoliosis is a chest wall disease which may cause restrictive lung disease. This would not be fitting with the obstructive pattern seen in this patient's results. It also would not explain the five-year history of symptoms, nor the recurrent infections.
10000634
d
Kyphoscoliosis
Concept
Chapter
2693
3800
Chronic Obstructive Pulmonary Disease (COPD)
Topic
162
General practice
12673
A 55-year-old female presents with a five-year history of dyspnoea and recurrent chest infections. She has smoked 20 cigarettes a day for 30 years. She undergoes lung function testing which produces the following results:

FVC 2.47 (predicted: 3.15)

FEV1 1.50 (predicted 1.70)

TLC 5.87 (predicted 4.39)

Which of the following is her most likely diagnosis?
a