Your patient is a 68-year-old male complaining of difficulty breathing for two days. He is sitting up, conscious, alert, and oriented and appears to be in mild respiratory distress. Physical examination reveals cool, dry, pink skin; he is thin with well-defined accessory muscles, and you note diffuse wheezing to all lung fields. HR = 102, BP = 136/96, RR = 20, SaO₂ = 92%. The patient gives a 20-pack-a-year history of smoking. These findings are most typical of: A) emphysema. B) asthma. C) chronic bronchitis. D) congestive heart failure.

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The patient's symptoms and history are most indicative of emphysema. Emphysema, a type of chronic obstructive pulmonary disease (COPD), is characterized by difficulty breathing, use of accessory muscles due to the effort of breathing, diffuse wheezing, and a significant smoking history. The presence of cool, dry, pink skin differentiates it from conditions like congestive heart failure, where you might expect to find signs of fluid overload such as edema. Asthma could present similarly but the long smoking history and the description of the patient being thin with well-defined accessory muscles lean more towards emphysema. Chronic bronchitis, another type of COPD, typically presents with productive cough, which is not mentioned here.

Your Patient Is a 68-Year-Old Male Complaining of Difficulty Breathing