A 71-year-old man presents to the pulmonary clinic reporting a 9-month history of progressively worsening shortness of breath and a dry, hacking cough. He denies fever, chills, orthopnea, paroxysmal nocturnal dyspnea, or chest pain. His past medical history is significant for hypertension and a 35-pack-year smoking history, having quit 10 years ago. Current medications include lisinopril and amlodipine.
Vital signs show a pulse of 86/min, respiratory rate of 22/min, blood pressure of 128/78 mm Hg, and oxygen saturation of 91% on room air. Physical examination reveals digital clubbing. Pulmonary auscultation demonstrates fine, end-inspiratory "Velcro-like" crackles predominantly at the lung bases bilaterally. Cardiac examination is normal with no murmurs, gallops, or jugular venous distention. There is no lower extremity edema.
Pulmonary function testing (PFT) reveals the following:
| Parameter | Patient Value | % Predicted |
|---|---|---|
| 1.9 L | 65% | |
| 2.2 L | 58% | |
| 86% | N/A | |
| 3.8 L | 56% | |
| 11.5 mL/min/mm Hg | 48% |
High-resolution computed tomography (HRCT) of the chest shows bilateral, subpleural reticular opacities with traction bronchiectasis and honeycombing.
Based on the clinical presentation and diagnostic findings, which of the following are accurate regarding this patient's condition? (Select all that apply)
- Initiation of antifibrotic therapy with pirfenidone or nintedanib is indicated to slow the decline in pulmonary function.Cevap
- The patient's arterial blood gas on room air is likely to show a widened alveolar-arterial () oxygen gradient.Cevap
- CThe physical examination findings represent left ventricular volume overload, and daily loop diuretics are the primary indicated therapy.
- DIf the patient's arterial is mm Hg, a normal compensatory response would result in an elevated serum bicarbonate level.
- EBroad-spectrum empiric antibiotic therapy should be initiated immediately to treat a presumed infectious etiology for his chronic cough.