Use the following patient vignette to answer questions 11 –…

Use the following patient vignette to answer questions 11 – 13. A 35-year-old man presents with sputum producing cough and dyspnea at rest.  Past medical history is significant for a previous diagnosis of premature emphysema at age 28.  The patient denies smoking and excessive alcohol intake or exposure to dust and mold.  Family history is significant for coronary artery disease and pulmonary disease in the patient’s father and only brother.   Vital signs are within normal limits except for blood pressure of 160/120 mmHg on three readings.  Physical examination reveals an ill-appearing man with prolonged expiratory time.   Auscultation of the lungs reveals end-expiratory wheezing.  ECG is within normal limits. 13. What is the next best diagnostic approach for this patient?

Use the following patient vignette to answer questions 32 –…

Use the following patient vignette to answer questions 32 – 33. A 23-year-old student at CWRU is taken to Student Health by his friend after passing out on a run. The student says he has been experiencing trouble breathing while he runs and has been feeling very tired most of the time. He denies smoking or drinking alcohol in excess. Past medical history is significant for 2 episodes of angina upon exertion. At the physical examination his vitals are HR 80 bpm with a loud P2 (pulmonic) heart sound, BP 120/75 mmHg, RR 18 bpm. He appears to have a slightly lifted sternum but the rest of his physical exam is normal.  CXR shows normal lung fields, with a slightly increased umbra of the pulmonary artery. Cardiac silhouette appears slightly enlarged in the CXR image. 33. What changes on an EKG might you expect to see in this patient?