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76-Year-Old Woman With Hemoptysis

Published:October 19, 2022DOI:
      A 76-year-old woman presented with 2 years of hemoptysis that had been increasing in frequency until it was happening on a daily basis. She had also experienced new hypoxia, exertional dyspnea, fatigue, and weight loss. Her past medical history was pertinent for severe scoliosis, remote myocardial infarction, heart failure with preserved ejection fraction (HFpEF), mild aortic stenosis, hypertension, and chronic kidney disease stage IV. She had no history of atrial fibrillation. Her medications included aspirin, high-intensity atorvastatin, furosemide, metoprolol tartrate, and lisinopril. She denied smoking tobacco or recent travel outside the United States. Vital signs showed heart rate of 84 beats per minute, blood pressure of 106/67 mm Hg, respiratory rate of 27, temperature of 37.1°C, and she was saturating well on 2 liters of oxygen via nasal cannula. Physical examination was pertinent for thin habitus, right lower-lobe crackles, loud P2 sound, elevated jugular venous pressure, trace bilateral lower extremity edema, and no abdominal distension or tenderness. Laboratory testing showed the following (reference ranges provided parenthetically): hemoglobin 8.2 g/dL (11.6 to 15.0 g/dL); platelet count 151 × 109/L (157 to 371 x109/L); international normalized ratio (INR) 1.0 (0.9 to 1.1); and activated partial thromboplastin time (aPTT) 31 seconds (25 to 37 seconds).
      • 1.
        Which of the following would be the least likely cause of this patient’s presentation?
        • a)
          Necrotizing pneumonia
        • b)
          Lung cancer
        • c)
          Granulomatosis with polyangiitis
        • d)
          Pulmonary arteriovenous malformation
        • e)
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      CORRECT ANSWERS: 1. a. 2. c. 3. b. 4. b. 5. a