A 70-year-old man has been smoking excessively for 30 years. What is the most common disease he is likely to develop?

Appeared in: SGPGI Nursing Officer-2024

Explanation

Chronic bronchitis is a form of Chronic Obstructive Pulmonary Disease (COPD) directly caused by long-term exposure to irritants.
Tobacco smoke is the primary cause, with about 90% of affected individuals being smokers.
The pathogenesis involves mucus hypersecretion from enlarged submucosal glands and chronic inflammation of the airways.
Smoking damages the airway lining and impairs ciliary action, preventing mucus clearance and increasing infection risk.
It is clinically defined by a persistent productive cough for at least 3 months in 2 consecutive years.

Option A: Sarcoidosis is an idiopathic inflammatory disorder involving granulomas in multiple organs, most commonly the lungs and lymph nodes. Its cause is unknown and it is not directly caused by smoking.
Option C: Glaucoma is a group of eye diseases that damage the optic nerve, typically due to increased intraocular pressure. Primary risk factors include age, family history, and ethnicity, not smoking.
Option D: While smoking is a known risk factor that increases the likelihood and accelerates the development of cataracts (clouding of the lens), it is not as common or as direct a consequence of long-term heavy smoking as chronic bronchitis.

Clinical Relevance

Nursing practice connection: Use the key finding related to Etiology and complications of chronic smoking to guide bedside assessment, documentation, and the next nursing action.
Nurses play a crucial role in identifying patients at high risk for COPD, such as long-term smokers.
Patient education on smoking cessation is a primary nursing intervention to prevent the onset or progression of chronic bronchitis.
Assessment for chronic bronchitis includes asking about the duration and character of any cough, sputum production, and shortness of breath.

How to Approach the Question

First, identify the key information in the clinical scenario: a 70-year-old man with a 30-year history of excessive smoking.
The question asks for the 'most common' disease he is likely to develop from this specific risk factor.
Analyze the options based on their relationship to long-term smoking.
Evaluate the strength of the association for each option. Smoking is the number one cause of chronic bronchitis.
Compare the relative risks. The link between smoking and chronic bronchitis is stronger and more direct than its link to cataracts or glaucoma.
Select the option with the strongest and most well-established causal link to the patient's history.

Concept Tested & Keywords

Concept Tested: Etiology and complications of chronic smoking
Stem keywords: 70-year-old man, smoking excessively, 30 years
Lead-in keywords: most common disease
Clinical cues: A 30-year history of excessive smoking is a significant risk factor for respiratory diseases.

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E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed pp. 684-686, 683-685

Practise the full SGPGI Nursing Officer-2024

Attempt every question from this paper in a timed mock, then review the full solution for each one.