A 65-Year-Old Man Comes to the Office Due to Progressively

question 477

Multiple Choice

A 65-year-old man comes to the office due to progressively worsening dyspnea and fatigue over the last 2 weeks.  His lifestyle is mostly sedentary with limited activities around the house, but he has had dyspnea for the past 3 days while at rest.  The patient was diagnosed with lung cancer a year ago and underwent surgical resection followed by chemotherapy.  Other medical conditions include chronic kidney disease and hypertension.  Temperature is 37 C (98.6 F) , blood pressure is 114/70 mm Hg, pulse is 95/min, and respirations are 20/min.  Pulse oximetry shows an oxygen saturation of 95% on room air.  Lungs are clear to auscultation bilaterally.  There are no heart murmurs.  Extremities are without edema.  Laboratory studies are as follows: Chest x-ray is shown in the exhibit.  What is the most appropriate next step in management of this patient?

• A)CT angiography of the chest
• B)Echocardiography
• C)Erythropoietin injection
• D)Furosemide therapy
• E)Pulmonary function studies

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