A 61-Year-Old Man Is Evaluated for Progressive Exertional Dyspnea and Decreased

A 61-year-old man is evaluated for progressive exertional dyspnea and decreased exercise tolerance.  He has also noticed some ankle swelling.  The patient has a 40-pack-year smoking history but no illicit drug use or occupational exposure.  Examination shows increased anteroposterior diameter of the chest.  Breath sounds are decreased throughout.  Heart sounds are distant.  The abdomen is soft and nontender.  Mild bilateral ankle edema is present.  His chest x-ray is shown below. Which of the following is the most likely effect of the abnormal diaphragmatic contour in this patient?

A) Decreased lung compliance
B) Higher inspiratory flow
C) Increased expiratory flow
D) Increased thoracic wall recoil
E) Increased work of breathing

Correct Answer:

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