Family Nurse Practitioner Exam

A 67-year-old female with a 50 pack/year smoking history shows signs of respiratory issues. What is the most likely diagnosis?

1. Bronchogenic carcinoma

2. COPD (chronic obstructive pulmonary disease)

3. Chronic bronchitis

4. Congestive heart failure

The correct answer is: COPD (chronic obstructive pulmonary disease)

In evaluating the case of a 67-year-old female with a significant smoking history and respiratory issues, the most likely diagnosis is chronic obstructive pulmonary disease (COPD). This condition encompasses a group of lung diseases, including emphysema and chronic bronchitis, and is primarily caused by long-term exposure to irritants that damage the lungs and airways, with cigarette smoke being the most common irritant. The patient's 50 pack/year smoking history significantly increases her risk for developing COPD. Symptoms often include persistent respiratory symptoms such as shortness of breath, chronic cough, and sputum production. While bronchogenic carcinoma is a concern in long-term smokers, the immediate presentation of respiratory issues in the context of the smoking history points more towards COPD, which is a progressive disease characterized by airflow limitation. Chronic bronchitis could also present in conjunction with COPD, but it is typically considered a component of the overall COPD diagnosis rather than a standalone condition when assessing the smoking history and respiratory symptoms in this context. Congestive heart failure, although it can present with respiratory symptoms, is less likely given the strong association between heavy smoking and COPD.