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COPD exacerbation — USMLE Step 2 CK MCQ

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ModerateInternal MedicineCOPD exacerbationUSMLE Step 2 CK

A 48-year-old Middle Eastern man comes to the urgent care clinic because of chest discomfort or shortness of breath. History and focused examination are notable for increased cough, sputum purulence, wheeze, and hyperinflation in a smoker. Temperature is 99.1°F (37.3°C), blood pressure is 118/74 mmHg, pulse is 116/min, respirations are 26/min, and oxygen saturation is 89% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Chest imaging and arterial blood gas testing show abnormalities matching the respiratory findings; serum electrolytes are within reference range. Which of the following is the most appropriate pharmacotherapy?

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Correct answer: C — Inhaled albuterol-ipratropium, systemic glucocorticoids, and antibiotics when indicated

The vignette describes COPD exacerbation, supported by increased cough, sputum purulence, wheeze, and hyperinflation in a smoker. Inhaled albuterol-ipratropium, systemic glucocorticoids, and antibiotics when indicated is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: GOLD 2025 Report