A 68-y old male with a longstanding history of cigarette smoking presents with a 3-month history of progressive shortness of breath and dyspnea on exertion. The symptoms have been ongoing and indolent. He reports chronic cough productive of his usual yellow sputum. Physical exam is notable for normal vital signs, prolonged expiratory phase and wheeze bilaterally, elevated jugular venous pressure, and moderate pedal edema. Hematocrit 49%. Which of the following is most likely to prolong his survival?

Correct Answer: D

Rationale: This patient likely has COPD with cor pulmonale (elevated JVP, edema). Long-term oxygen therapy is proven to prolong survival in hypoxemic COPD patients by reducing pulmonary hypertension and improving tissue oxygenation, as shown in trials like the NOTT and MRC studies.

Correct Answer: B

Rationale: Persistent cough (B) and crackles (D) are more typical of left-sided heart failure due to pulmonary congestion. Right-sided heart failure typically presents with jugular venous distention (A), weight gain (C), and nocturia (E), while orthopnea (F) is more left-sided.

Correct Answer: D

Rationale: Labetalol decreases sympathetic nervous system activity by blocking both α-and β-adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause severe orthostatic hypotension. Heart palpitations, dry mouth, dehydration, and headaches are possible side effects of other antihypertensives.

Correct Answer: D

Rationale: The P wave on an EKG represents atrial depolarization, which precedes atrial contraction.

Correct Answer: B

Rationale: Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines and acetaminophen do not increase BP. Stressful events will increase BP but not usually to the level seen in this patient.