Assignment Task:
A 76-year-old woman presents to the internal medicine clinic for follow-up after a recent hospitalization for weakness and hyponatremia. The reason for her hospitalization was eventually attributed to diuretic side effects. The patient has noted shortness of breath with routine activities at home. She has no significant cough or sputum production, no prior diagnosis of any chronic lung disease, and no chest pain. She has smoked approximately 40 pack-years but quit smoking 20 years prior to this clinic visit. Her physical examination revealed a thin frail woman who appeared to have diffuse weakness. She had decreased breath sounds at both lung bases but no wheezes. There was no peripheral edema. Pulmonary function testing revealed a forced vital capacity (FVC) of 1.99 L (88% of predicted), a forced expiratory volume in the first second (FEV1) of 1.36 L (76% of predicted), a total lung capacity of 4.88 L (124% of predicted), a residual volume of 2.84 L (171% of predicted), and a corrected diffusion capacity of 78% of predicted. Her chest x-ray revealed increased lung volumes and decreased vascular markings. What is the most likely diagnosis? What is the next diagnostic step? What age-related concerns do you have regarding treatment? Need Online Tutoring?