American College of Physicians: Internal Medicine — Doctors for Adults ®

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The MKSAP Challenge

From the April ACP Observer, copyright © 2006 by the American College of Physicians.

Clinical scenario

A 64-year-old man with severe chronic obstructive pulmonary disease (COPD) with mild hypercapnia and persistent dyspnea on minimal exertion is evaluated in the office.

He is on maximal bronchodilator therapy and oral theophylline. He was admitted two months ago to the intensive care unit for an exacerbation of COPD and was placed on noninvasive ventilation by bilevel positive airway pressure. He subsequently improved and was discharged home.

Which of the following outcomes is likely if this patient uses bilevel positive airway pressure at home?

A. Decreased frequency of COPD exacerbations
B. Decreased likelihood of death caused by COPD
C. Improvement in symptoms and quality of life
D. Improvement in hypercapnia
E. No benefit

Answer

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