A 65-Year-Old Woman with Known Chronic Obstructive Pulmonary Disease Seeks

A 65-year-old woman with known chronic obstructive pulmonary disease seeks evaluation due to pain in both of her knees and warmth in her fingertips.  She has a 50-pack-year smoking history and quit 5 years ago.  She has never been hospitalized for respiratory symptoms.  The patient uses a tiotropium inhaler daily and albuterol as needed for shortness of breath.  She also takes lisinopril for hypertension and bisacodyl for chronic constipation.
Her blood pressure is 144/85 mm Hg and pulse is 90/min.  She has decreased breath sounds bilaterally and a mildly prolonged expiratory phase of respiration.  There is a grade 1/6 systolic murmur along the left upper sternal border.  The finger joints and both knees have some mild warmth and slight tenderness to palpation, with normal range of motion.  Mild finger clubbing is present.
What is the best next step in management of this patient?

A) Chest imaging study
B) Ibuprofen and reassurance
C) Liver function tests
D) Low-dose prednisone
E) Transthoracic echocardiogram

Correct Answer:

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