A 60-Year-Old Man Comes to the Physician with a 2-Year

question 787

Multiple Choice

A 60-year-old man comes to the physician with a 2-year history of slowly progressive dyspnea on exertion.  Over the last 6 months, he has had a frequent nonproductive cough, malaise, and a 4.5-kg (10-lb) weight loss.  He ran and biked every day prior to developing these symptoms.  His past medical history includes hypertension treated with hydrochlorothiazide.  Prior to retiring 3 years ago, he worked in a rock quarry for 25 years.  He has a 30-pack-year smoking history and quit 10 years ago,
His temperature is 36.7° C (98° F) , blood pressure is 138/88 mm Hg, pulse is 88/min, and respirations are 16/min.  Pulse oximetry is 92% at rest on room air.  Physical examination shows a thin man in no acute distress.  Jugular venous pressure is estimated at 5 cm.  Lung examination is notable for fine crackles in the upper- and mid-lung fields.  The remainder of the examination is normal.
Results of pulmonary function tests are as follows:

Chest x-ray reveals bilateral interstitial infiltrates in the upper lung fields.  High-resolution computed tomography of the chest demonstrates diffuse micronodules and fibrotic lung changes in the upper lobes bilaterally.
Which of the following is the most likely cause of the patient's symptoms?

• A)Asbestosis
• B)Bronchogenic lung cancer
• C)Idiopathic pulmonary fibrosis
• D)Sarcoidosis
• E)Silicosis

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Definitions:

Observes

To notice or perceive something and register it as being significant, typically by paying close attention or by scrutinizing.

Median

A measure of central tendency which represents the value separating the higher half from the lower half of a data sample, population, or probability distribution.

Case Study

An in-depth examination of a single subject or incident to explore causation to find underlying principles.

Descriptive Study

A research method focused on describing characteristics of a population or phenomenon being studied.