04-21-2008, 06:40 PM
A 65-year-old retired accountant with a 60-pack-year smoking history presents for his annual
physical examination. He was last seen 3 years ago, when he presented with an episode of
acute bronchitis. He reports that he has been coughing over the past several months with
productive green sputum. He denies any dyspnea or limitation in his daily activities. On
physical examination, his blood pressure is 126/62 mm Hg, pulse is 80/min, and respirations
are 24/min. He has diffuse bilateral expiratory rhonchi with a markedly prolonged expiratory
phase. His cardiac examination reveals a second heart sound that increases in intensity with
inspiration. The liver edge is 14 cm into the midclavicular line and mildly tender to palpation.
There is bilateral lower extremity edema to the knees. A chest x-ray film reveals hyperinflation
of both lung fields, and pulmonary function tests reveal a diminished forced expiratory volume
in 1 second (FEV1) to forced vital capacity (FVC) ratio. Routine laboratories are sent. Which of
the following would most likely be expected?
A. A hemoglobin of 9 g/dL
B. A hemoglobin of 17 g/dL
C. A platelet count of 84,000
D. A platelet count of 102,000
E. A white blood cell count of 3400
physical examination. He was last seen 3 years ago, when he presented with an episode of
acute bronchitis. He reports that he has been coughing over the past several months with
productive green sputum. He denies any dyspnea or limitation in his daily activities. On
physical examination, his blood pressure is 126/62 mm Hg, pulse is 80/min, and respirations
are 24/min. He has diffuse bilateral expiratory rhonchi with a markedly prolonged expiratory
phase. His cardiac examination reveals a second heart sound that increases in intensity with
inspiration. The liver edge is 14 cm into the midclavicular line and mildly tender to palpation.
There is bilateral lower extremity edema to the knees. A chest x-ray film reveals hyperinflation
of both lung fields, and pulmonary function tests reveal a diminished forced expiratory volume
in 1 second (FEV1) to forced vital capacity (FVC) ratio. Routine laboratories are sent. Which of
the following would most likely be expected?
A. A hemoglobin of 9 g/dL
B. A hemoglobin of 17 g/dL
C. A platelet count of 84,000
D. A platelet count of 102,000
E. A white blood cell count of 3400