A 60-Year-Old Caucasian Female Comes to the Physician Because of Progressive

question 271

Multiple Choice

A 60-year-old Caucasian female comes to the physician because of progressive shortness of breath for the past month. She has had a 13.6 kg (30 lb) weight loss during this period. She has a history of hypertension and hypothyroidism and takes metoprolol and levothyroxine. She has smoked two packs of cigarettes daily for 35 years. Her temperature is 36.7° C (98° F) , blood pressure is 130/70 mmHg, pulse is 80/min, and respirations are 20/min. On examination, decreased breath sounds and dullness to percussion are noted on the right, middle and lower lobes of the lung. Her chest x-ray is shown below. Which of the following is the most appropriate next step in the management?

• A)Bronchoscopy
• B)Mediastinoscopy
• C)Thoracentesis
• D)Video-assisted thoracoscopy
• E)Open pleural biopsy
• F)Echocardiography
• G)Diuretics