A female patient, age 50, appears with a three-month history of a cough that produces phlegm and is worse in the morning after getting up. The sputum has a little to moderate amount, a middling consistency, and a pale yellow tint. No recent ill contacts or fever are present. Rhonchi are sometimes heard bilaterally during auscultation, particularly in the lower lobes. The patient has never smoked. What do you suggest?
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A
The patient needs pulmonary rehabilitation with exercise and nutritional counseling.
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B
A more complete history including vocation, exposure to environmental hazards, and family history is required. Also, PFTs are indicated for this patient with a pre- and post-bronchodilator FEV1/FVC.
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C
Tell the physician that the patient has COPD and needs a long-acting beta agonist and an inhaled corticosteroid to start at once.
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D
An order for a stat CXR and a complete blood count (CBC) with differential is necessary to rule out pneumonia.