A 64-Year-Old Woman Comes to the Office Due to Worsening

question 310

Multiple Choice

A 64-year-old woman comes to the office due to worsening dyspnea on exertion and a "whistling noise" while breathing heavily during exercise.  These symptoms have worsened over the past 3 months.  The patient has had no cough, fever, hoarseness, or weight change.  She has hypertension and hyperlipidemia and had a coronary artery bypass graft 4 years ago.  Physical examination reveals no cardiopulmonary abnormality.  A flow-volume loop demonstrates the following:

What is the most likely etiology of this patient's symptoms?

• A)Adult-onset asthma
• B)Emphysema
• C)Obstructive substernal goiter
• D)Tracheomalacia
• E)Unilateral vocal cord paralysis

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Definitions:

Tonnes

A metric unit of mass equivalent to 1,000 kilograms or approximately 2,204.6 pounds.

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A facility where raw materials are processed, refined, or transformed into finished products through various mechanical or chemical procedures.

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The expenses associated with moving goods from one location to another, including fuel, labor, and maintenance of vehicles.

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