A 42-Year-Old Man Comes to the Physician with Complaints of Daytime

question 89

Multiple Choice

A 42-year-old man comes to the physician with complaints of daytime sleepiness, dyspnea on exertion, and impaired concentration.  His other medical problems include hypertension and type 2 diabetes mellitus.
His temperature is 36.1° C (97° F) , blood pressure is 162/85 mm Hg, pulse is 92/min, and respirations are 14/min.  His BMI is 40 kg/m².  The patient's pulse oximetry is 94% on room air.  Examination shows jugular venous distention, clear lung fields, loud second heart sound, and 2+ pretibial edema bilaterally.
Laboratory results are as follows:

Chest x-ray shows low lung volumes but is otherwise unremarkable.  Spirometry shows a FEV₁ of 70% of predicted and a FEV₁/FVC ratio of 90%.  Transthoracic echocardiography is limited by body habitus but shows mild right ventricular enlargement.
Which of the following is the best initial therapy for this patient?

• A)Acetazolamide
• B)Appetite suppressant
• C)Chronic oxygen therapy
• D)Positive-pressure ventilation
• E)Structured exercise program

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Definitions:

Pancreatic Duct

A duct connecting the pancreas to the duodenum, through which pancreatic juices flow to aid in digestion.

Zona Reticularis

Inner layer of the adrenal cortex that secretes androgens and estrogens.

Insulin Shock

A severe hypoglycemic condition resulting from an overdose of insulin, leading to low blood sugar levels, confusion, and unconsciousness.

Alpha Cells

Endocrine cells in the pancreas that produce glucagon, which raises blood glucose levels.