A 65-Year-Old Woman Comes to the Office Reporting Progressively Increasing

A 65-year-old woman comes to the office reporting progressively increasing orthopnea, daytime fatigue, and morning headache for the last month.  She has had no chest pain or problems with swallowing or speech.  Medical conditions include myocardial infarction, type 2 diabetes, hypertension, and amyotrophic lateral sclerosis.  Temperature is 37 C (98.6 F) , blood pressure is 130/70 mm Hg, pulse is 88/min, and respirations are 16/min.  Pulse oximetry shows 95% on room air.  BMI is 24 kg/m².  Examination shows normal jugular venous pressure, clear lungs, and normal heart sounds.  There is no peripheral edema.  Neurologic examination shows 3/5 power in right lower extremity and 4/5 power in left lower extremity and muscle atrophy, unchanged from her last examination 2 months ago.  Laboratory results are as follows: Which of the following is the most appropriate next step in management?

A) Furosemide
B) Home oxygen therapy
C) Modafinil
D) Noninvasive positive-pressure ventilation
E) Tiotropium
F) Tracheostomy

Correct Answer:

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