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A 61-year-old man presents with shortness of breath. His temperature and other vital signs are normal. The patient has a long history of aortic valvular insufficiency. His spouse reports that the patient takes all prescribed medications regularly. He has never smoked and denies any history of lung disease, but pulmonary function testing now shows an obstructive pattern. A new chest radiograph shows an enlarged heart and evidence of bilateral pulmonary edema. What mechanism most likely accounts for the airway obstruction in this patient?

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The correct answer is E. You answered E.

The most correct answer is e.

The man’s aortic insufficiency has worsened to now distend the left atrium and pulmonary veins, and initiate cardiogenic edema that increases airway resistance. Because he does not smoke, is not febrile, and his sputum production is not remarkable, he likely does not have pneumonia (answers b and c) or emphysema (answer d). Increased cardiac dimensions (answer a) are more common in patients with congestive heart failure secondary to systemic hypertension; in any case such cardiomegaly would rarely reduce the diameters of conducting airways directly.


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