A 58-year-old woman presents to her has had on and off for several years and intermittent shortness of breath since last year. She denies sputum production, rhinorrhea, sneezing, or nasal congestion. She has been a smoker for 40 years. Past medical history is negative physician with a recurrent cough that she for asthma or allergic rhinitis. Her temperature is 36.9°C (98.4°F), heart rate is 80/min, respiratory rate is 22/min, and blood pressure is 128/84 mm Hg. A physical examination reveals diffuse end-expiratory wheezing with prolonged expiration; the breath and heart sounds are diminished. There is no cyanosis, clubbing, or lymphadenopathy. Her chest radiograph shows hyperinflated lungs bilaterally, and a CT scan of her chest is shown in the picture. Which of the following best describes the pathogenesis of this patient's condition?
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A 56-year-old woman presents to the emergency department with a 1-hour history of persistent nasal bleeding that started spontaneously. The patient experienced a similar episode last year. She has a history of hypertension for which she takes hydrochlorothiazide and losartan. Her blood pressure is 135/88 mm Hg. During the examination, the patient is holding blood-stained gauze against her right nostril. Upon removal of the gauze, blood slowly drips from her right nostril. Examination of the left nostril reveals no abnormalities. Direct pressure for 20 minutes fails to control bleeding. What is the most appropriate next step in managing this patient?
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A 68-year-old man presents to the office with progressive shortness of breath and cough. A chest X-ray shows prominent hilar lymph nodes and scattered nodular infiltrates. Biopsy of the scattered nodular infiltrates reveals noncaseating granulomas. Which occupational exposure is most likely in this patient?
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A 57-year-old woman presents to her physician with a persistent cough that has become more frequent over the past few months. It is occasionally associated with yellowish sputum more in the morning than the rest of the day. She has been a heavy smoker for about 35 years now, smoking 2 packs a day. She has never been interested in quitting. Over the last 2 years, she has not gone more than 2 months without a daily cough. She has not been hospitalized in the past year. On examination, her temperature is 37°C (98.6°F), heart rate 85/min, respiratory rate 18/min, and blood pressure is 110/70 mm Hg. There is scattered expiratory wheezing in the lower lung fields. Her forced expiratory volume in the first second (FEV₁) is 83%, and her FEV₁/FVC post-bronchodilator ratio is 0.65. Her physician recommends that she quit smoking and asks if she is ready to consider that. She is advised to have pneumococcal and influenza vaccinations. Which of the following medications would be most appropriate to assist the patient with her symptoms at this time?
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A 58-year-old man presents to his physician because of shortness of breath with exertion for the last 2 years. He mentions that initially, he used to become breathless upon climbing 2 flights of stairs, but now he becomes short of breath after walking a couple of blocks. He has no known medical problems except obesity (BMI 36 kg/m²). There is no history of substance abuse. His temperature is 36.9°C (98.4°F), heart rate is 90/min, respiratory rate is 20/min, and blood pressure is 130/88 mm Hg. A cardiac exam reveals a loud pulmonic component of the second heart sound, and the pulmonary exam is normal. A chest X-ray shows enlargement of the central pulmonary arteries, attenuation of the peripheral pulmonary vessels, and oligemic lung fields, consistent with pulmonary hypertension. In addition to measures for weight reduction, which of the following is most likely to improve this patient's shortness of breath?
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A 32-year-old man with shortness of breath for 3 hours presents to the emergency department (ED). He feels drowsy but denies fever, nasal discharge, cough, chest pain, or palpitations. He has a history of aplastic anemia and received multiple packed red blood cell transfusions over the past week. Vital signs are temperature 38.4°C (101.0°F), heart rate 114/min, respiratory rate 32/min, blood pressure 104/84 mm Hg, and oxygen saturation 70% on room air. On physical exam, he is cyanotic and has decreased breath sounds bilaterally with diffuse crackles in all lung fields. There are no abnormal heart sounds or murmurs and no peripheral edema. He is stabilized and intubated for mechanical ventilation. Lab results show a normal BNP of 70 pg/mL and a PaO₂/FiO₂ ratio of 210 mm Hg. A chest X-ray shows bilateral opacities. What is the most likely pathophysiological mechanism in this patient's disease process?
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