#june2020mccqe1
A 63-year-old man is evaluated for a 1-year history of dyspnea that has gradually worsened during the past 6 months. He has dyspnea at rest, but has no orthopnea. The patient reports his breathing is better when lying flat and is worse when sitting upright. He previously abused alcohol and intravenous drugs. Medical history is significant for cirrhosis and portal hypertension. On physical examination, the patient is afebrile. Blood pressure is 110/68 mm Hg, pulse rate is 80/min, and respiration rate is 24/min. Oxygen saturation by pulse oximetry is 85% on ambient air. The cardiac examination is normal. Lungs are clear. Ascites is present as are clubbing, peripheral cyanosis, and spider nevi. Lower extremities show 1+ pitting edema.
The chest x-ray is normal.
Which of the following is the most likely cause of this patient's dyspnea?
(A) Bronchogenic carcinoma
(B) Constrictive pericarditis
(C) Emphysema
(D) Hepatopulmonary syndrome
A 63-year-old man is evaluated for a 1-year history of dyspnea that has gradually worsened during the past 6 months. He has dyspnea at rest, but has no orthopnea. The patient reports his breathing is better when lying flat and is worse when sitting upright. He previously abused alcohol and intravenous drugs. Medical history is significant for cirrhosis and portal hypertension. On physical examination, the patient is afebrile. Blood pressure is 110/68 mm Hg, pulse rate is 80/min, and respiration rate is 24/min. Oxygen saturation by pulse oximetry is 85% on ambient air. The cardiac examination is normal. Lungs are clear. Ascites is present as are clubbing, peripheral cyanosis, and spider nevi. Lower extremities show 1+ pitting edema.
The chest x-ray is normal.
Which of the following is the most likely cause of this patient's dyspnea?
(A) Bronchogenic carcinoma
(B) Constrictive pericarditis
(C) Emphysema
(D) Hepatopulmonary syndrome
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