A 58-Year-Old Man Comes to the Office Due to Exertional

A 58-year-old man comes to the office due to exertional dyspnea and cough.  His symptoms started 6 months ago and have progressively worsened.  Other medical problems include recurrent pyelonephritis, peptic ulcer disease, and rheumatoid arthritis.  The patient had taken a medication for rheumatoid arthritis for many years but stopped a year ago, as the drug failed to improve his worsening hand arthritis.  He does not use tobacco, alcohol, or illicit drugs.  Physical examination shows joint disease consistent with rheumatoid arthritis.  Chest x-ray is shown in the image below. Which of the following is the most likely explanation for this patient's pulmonary symptoms?

A) Bilateral atelectasis
B) Left ventricular failure
C) Obstructive lung disease
D) Pulmonary fibrosis
E) Pulmonary hypertension

Correct Answer:

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