A 54-Year-Old Man Comes to the Office Due to 6

question 1061

Multiple Choice

A 54-year-old man comes to the office due to 6 months of fatigue, anorexia, and a 7-kg (15.4-lb) unintentional weight loss.  The patient has noticed that despite his weight loss, his pants are getting tighter and his socks leave deep imprints on his legs.  He has a history of hypertension for which he takes amlodipine.  He is unaware of any family history as he was adopted.  The patient has smoked 5-6 cigarettes daily for the past 30 years and drinks 1 or 2 cans of beer on weekends.  He has a remote history of injection drug use.  Blood pressure is 134/82 mm Hg, pulse is 84/min, and BMI is 23 kg/m².  Jugular venous pressure is normal.  The patient has bilateral gynecomastia and several spider angiomas on his upper trunk.  Cardiac examination reveals normal heart sounds without any murmurs.  Breath sounds are decreased at the bases.  The abdomen is soft, nontender, and distended with shifting dullness.  There is bilateral lower extremity pitting edema.  Which of the following is the most likely underlying cause of this patient's condition?

• A)Adverse medication effect
• B)Chronic viral infection
• C)Cor pulmonale
• D)Hypothyroidism
• E)Lung cancer
• F)Nephrotic syndrome

---

Definitions:

Impaired Vision

A reduction in visual ability that cannot be corrected fully with glasses, contact lenses, eye drops, or surgery.

Overhead Lighting

Illumination provided from lights installed on a ceiling, offering broad, consistent light coverage in a room or area.

Large-print Books

Books printed with larger than normal letters to assist individuals with vision impairments.

Temporal Lobe

A region of the cerebrum that lies beneath the temples, responsible for processing auditory information and is involved in memory formation and speech.