A 31-Year-Old Man Comes to the Office Due to Progressive

question 53

Multiple Choice

A 31-year-old man comes to the office due to progressive dyspnea over the past several months.  The patient states that the shortness of breath improved initially with supine positioning, but lately, it is present even on recumbency and during minimal exertion.  He reports recurrent episodes of nosebleeds since childhood but has no other medical conditions.  Temperature is 36.7 C (98.1 F) , blood pressure is 110/50 mm Hg, pulse is 102/min, and respirations are 20/min.  Oxygen saturation is 96% on room air.  Cardiac examination reveals an accentuated S2 over the upper left sternal border.  The lungs are clear to auscultation.  There is digital clubbing.  Skin examination findings are shown in the exhibit.  Which of the following is the most likely underlying cause of this patient's dyspnea?

• A)Airway obstruction
• B)Endocardial infection
• C)Pulmonary fibrosis
• D)Valvular dysfunction
• E)Vascular malformation

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Definitions:

Primary Prevention

Strategies and activities aimed at preventing a problem before it occurs by removing causal risk factors.

Health Promotion

The process of enabling people to increase control over and improve their health through various strategies and approaches.

Informational Health Appeals

A type of health communication strategy that utilizes facts and information to encourage individuals to make healthier choices.

Credible

Being trustworthy or believable based on evidence, reputation, or reliability.