A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough,dyspnea,fatigue,hemoptysis,and weight loss over the past 2 months.The physical exam reveals decreased breath sounds and dullness to percussion over the left lower lung field.The chest x-ray demonstrates shift of the mediastinum and trachea to the left.These are classic signs of:

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The patient's history of smoking, chronic cough, dyspnea, fatigue, hemoptysis, weight loss, and physical exam findings of decreased breath sounds and dullness to percussion over the left lower lung field, as well as the chest x-ray demonstrating shift of the mediastinum and trachea to the left, are all classic signs of lung cancer. Tuberculosis may present with some of these symptoms, but the physical exam and chest x-ray findings would be different. Pneumonia typically presents with fever, productive cough, and infiltrates on chest x-ray. COPD may present with some of these symptoms but not the shift of the mediastinum seen in this patient.

A 76-Year-Old Patient with a 200-Pack Year Smoking History Presents