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Delirium — USMLE Step 2 CK MCQ

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HardPsychiatryDeliriumUSMLE Step 2 CK

A 67-year-old with COPD has two steroid-treated exacerbations in the past year despite correct LABA-LAMA use. Blood eosinophils are 410 cells/µL, inhaler technique is good and there is no asthma history. Which maintenance change is most appropriate?

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Correct answer: D — Add an inhaled corticosteroid to create triple therapy

Two exacerbations despite correct LABA-LAMA therapy plus an eosinophil count of 410 cells/µL favor adding an inhaled corticosteroid to create triple therapy. Switching to ICS-LABA would remove a long-acting muscarinic antagonist and is less appropriate than triple therapy. Roflumilast is considered especially with chronic bronchitis and severe airflow limitation, neither specified. Long-term azithromycin is an alternative in selected exacerbation-prone patients, particularly former smokers with lower eosinophilic signal, but carries resistance and cardiac risks. Chronic oral prednisone is not recommended for stable COPD.

Reference: GOLD 2026 global strategy for COPD: https://goldcopd.org/2026-gold-report-and-pocket-guide/