A 69-Year-Old Man Comes to the Office with a 6-Month

question 203

Multiple Choice

A 69-year-old man comes to the office with a 6-month history of dry cough and progressive exertional dyspnea.  The patient smoked a pack of cigarettes a day for 40 years but quit 15 years ago.  He owns 2 parrots and a cat.  He feels that his symptoms improved somewhat while on vacation 2 months ago.
On examination, blood pressure is 138/92 mm Hg, pulse is 84/min, and respirations are 18/min.  Pulse oximetry is 90% on room air.  Chest auscultation shows bilateral crackles with mild end-expiratory wheeze and a 2/6 systolic murmur at the left sternal border.  Digital clubbing is present.
Pulmonary function testing shows a restrictive defect with impaired gas exchange.  A CT scan of the chest reveals bilateral patchy ground-glass opacities, mostly in the mid-upper lung fields.  There is no lymphadenopathy.
Which of the following is the most likely diagnosis?

• A)Chronic obstructive pulmonary disease
• B)Hypersensitivity pneumonitis
• C)Idiopathic pulmonary fibrosis
• D)Moderate persistent asthma
• E)Sarcoidosis

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Definitions:

Heritability

The proportion of observed variation in a particular trait among individuals of a population that can be attributed to inherited genetic factors.

Medium Ground Finch

A species of bird in the Galapagos Islands, known for its variable beak size, studied in the context of natural selection.

Australian Snake

Reptiles found in Australia, known for both venomous and non-venomous species, playing crucial roles in the ecosystem as predators and prey.

Gallflies

Insects known for forming galls, or abnormal growths, on plants, especially notable in the gall wasp family (Cynipidae).