A 59-year-old female presents to the office because she is “sick and tired” of this cough she has had for 5 years, and it is getting worse. The cough is often productive of watery mucus. She is also becoming increasingly short of breath and cannot climb a flight of stairs without taking a rest. She does not have chest pain, paroxysmal nocturnal dyspnea, fevers, chills, or weight loss. PMH is significant for HTN and a 35-pack-year history of cigarette smoking. Vital signs are as follows: Temperature = 99.0°F, HR 75, RR 21, BP 158/82 mm Hg. O2 saturation is 94% at rest and reaches a nadir of 90% with activity. Physical examination reveals an obese woman in no acute distress. On lung auscultation, there are coarse breath sounds bilaterally but no wheezes or crackles. Chest radiograph is significant for prominent lung markings at the bases. PFTs show FEV1/FVC ratio 0.60 and FEV1 65%.What is the most effective long-term intervention for this woman?Ask StudybuddyGroup of answer choicesAzithromycinSalmeterol inhalerSmoking cessationOxygen therapyTiotropium inhaler

A 43-year-old male presents to your office with a 3-day history of chest pain, which is centrally located and radiates to the right side of his neck. The pain worsens with deep breathing and improves when he sits up. He has no nausea, vomiting, sweating, or SOB. He had an upper respiratory infection about 2 weeks ago, which resolved without treatment. PMH is significant for hyperlipidemia. He takes rosuvastatin. He smokes half a pack of cigarettes a day. Vital signs are: temperature 99.4°F, BP 125/80 mm Hg, pulse 84. Physical examination is significant for a friction rub over the left sternal border heard best when he leans forward. A 12-lead ECG shows diffuse ST elevation in leads I, II, III, aVL, and V2 through V6. Echocardiogram shows an EF 50% with no regional wall motion abnormalities and normal valvular function. There is a small pericardial effusion. What is the most appropriate next step?

A 49-year-old man presents to the Emergency Department complaining of fever and a productive cough for several weeks. He also endorses night sweats and perceived weight loss. The patient is homeless and is a known alcoholic. On examination, the patient's temperature is 38.3°C, blood pressure is 144/90 mmHg, heart rate is 94 beats per minute, and respiratory rate is 20 breaths per minute. He appears weak and disheveled with poor dentition. There are bronchial and amphoric breath sounds at the right lung base. His laboratory values are significant for a hemoglobin of 11.8 g/dL and a leukocyte count of 13,500/mm3. Blood and sputum cultures are collected and sent to the laboratory.What should be done next in the management of this patient?

A 32-year-old man comes to the physician complaining of fever, shortness of breath, and a productive cough that has developed slowly over the past week. He has no other medical history and does not take any medications. His temperature is 38.5°C, blood pressure is 122/78 mmHg, heart rate is 68 beats per minute, respiratory rate is 18 breaths per minute, and oxygen saturation is 98% on room air. There are decreased breath sounds and dullness to percussion over the right lung base. The rest of the physical examination, including cardiac auscultation, is normal. A chest x-ray confirms consolidation of the right lower lobe. What is the most appropriate course of action for this patient?

A 38-year-old woman presents with progressive shortness of breath and a chronic dry cough. Initially, she presented to her primary care provider and had a chest x-ray performed which showed prominent reticular markings in the lung fields. She has no relevant medical history and does not take any medications. She denies any fevers, weight loss, or chest pain. There is a family history of hypertension and dyslipidemia, but no lung or heart disease. She works as a receptionist and has never smoked. On physical examination, there are dry rales throughout both lung fields with scattered wheezes. There is no focal dullness to percussion. Initial laboratory tests are ordered and show a normal hemoglobin and leukocyte count, as well as normal electrolytes and liver enzymes. HIV testing is performed and is negative. Which of the following should be done next in the workup of this patient?Ask StudybuddyGroup of answer choicesBronchoscopyHigh-resolution computed tomographyLung tissue biopsyChest x-ray

A 51-year-old woman comes to the office because of fatigue and progressive exertional dyspnea during the past several months. She has not had fever, cough, chest pain, palpitations, or weight loss. She has a history of type 2 diabetes mellitus and hyperlipidemia and takes glyburide and simvastatin. Screening colonoscopy 1 year ago showed no abnormalities. The patient does not smoke cigarettes, drink alcohol, or use illicit drugs. BMI is 32 kg/m2. Her temperature is 37.0°C (98.6°F), pulse is 92/min, respirations are 12/min, and blood pressure is 115/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. Physical examination shows mucosal and conjunctival pallor. The lungs are clear to auscultation. Cardiac examination discloses no murmurs. The abdomen is nontender to palpation. No peripheral edema is noted. Laboratory studies show:Hemoglobin 8.8 g/dLMean corpuscular volume 79 μm3Leukocyte count 6,300/mm3Platelet count 210,000/mm3Reticulocyte count 0.4%Hemoglobin A1c 7.8%Serum   Sodium 140 mEq/L   Potassium 4.3 mEq/L   Creatinine 0.9 mg/dL   Thyroid-stimulating hormone 1.2 μU/mLTest of the stool for occult blood is negative. Chest x-ray shows no abnormalities. Which of the following is the most likely underlying pathophysiology causing anemia in this patient?A. Acquired inhibition of aminolevulinic acid synthaseB. Immune-mediated hemolysisC. Increased erythrocyte recycling by macrophagesD. Intermittent nocturnal hypoxemiaE. Release of inflammatory cytokines