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A 76-Year-Old Man Comes to the Office Due to Nonproductive

question 270

Multiple Choice

A 76-year-old man comes to the office due to nonproductive cough and progressive shortness of breath on exertion for the past 6 months. He uses 2 pillows at night to sleep and occasionally wakes up to urinate. The patient has had no chest pain, weight loss, night sweats, or joint pains. Two months ago, another physician started him on furosemide, which has provided little symptomatic relief. Other medical conditions include hypertension and hypercholesterolemia. The patient is an ex-smoker with a 40-pack-year history; he quit 10 years ago. He used to play golf regularly but stopped 3 months ago because he felt too winded.
Blood pressure is 144/78 mm Hg and pulse is 89/min and regular. Oxygen saturation is 93% on room air. BMI is 30 kg/m². Jugular venous pressure is estimated at 10 cm H₂O. Bibasilar crackles are heard on lung auscultation. The apical impulse is not displaced. A faint holosystolic murmur is heard at the lower sternum and increases with inspiration. The abdomen is soft and nontender. Liver span is 11 cm and there is no splenomegaly. Digital clubbing and trace ankle edema are present.
ECG shows normal sinus rhythm and nonspecific T-wave changes. Chest x-ray reveals prominent interstitial markings and decreased lung volumes.
Which of the following is most likely to establish this patient's diagnosis?

Definitions:

Dosage

The size, frequency, and number of doses.

Nonpharmacologic

Pertaining to methods of treatment that do not involve medication.

Pain Management

A multidisciplinary approach intended to alleviate or reduce pain severity, improving an individual's quality of life.

General Anesthesia

A medically induced coma with loss of protective reflexes, resulting from the administration of one or more general anesthetic agents.