A 76-Year-Old Man Is Seen in the Emergency Department with Cough

question 3

Multiple Choice

A 76-year-old man is seen in the emergency department with cough and worsening dyspnea over the last 2 days.  He awoke suddenly last night gasping for air and could not get comfortable in any position.  He has no fever or chills.  The patient's other medical problems include hypertension and type 2 diabetes mellitus.  He has a 40-pack-year smoking history and drinks beer occasionally.
His temperature is 37.2° C (99° F) , blood pressure is 150/90 mm Hg, pulse is 106/min, and respirations are 25/min.  Pulse oximetry is 94% on 2 L O₂.  Body mass index is 35 kg/m².  Jugular venous pressure is measured at 12 cm H₂O.  He appears in mild respiratory distress.  Heart sounds are distant but no murmurs are heard.  Lung examination shows bibasilar crackles and scattered bilateral wheezes.  There is 1+ pitting ankle edema seen bilaterally.
Laboratory results are as follows:

Chest x-ray reveals prominent vascular markings and blunting of costophrenic angles.  Echocardiogram shows a diffusely hypokinetic left ventricle with ejection fraction of 35%.
Which of the following best explains the normal brain natriuretic peptide value?

• A)High body mass index
• B)Hypertension
• C)Hyponatremia
• D)Noncardiac cause of dyspnea
• E)Older age

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Definitions:

Science

A systematic enterprise that builds and organizes knowledge in the form of testable explanations and predictions about the universe.

CAM

Complementary and Alternative Medicine (CAM) refers to medical products and practices that are not part of standard medical care, often involving herbal remedies, acupuncture, and massage therapy.

Biomedical View

An approach in medicine that focuses on biological factors in understanding and treating disease, often neglecting psychological and social factors.

Biopsychosocial View

A holistic approach to understanding human health and illness, considering biological, psychological, and social factors.