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Old 08-14-2015
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Default Remembered USMLE Question 622

A 65 year-old farmer presents to your clinic complaining of shortness of breath for 6 months. Last 2 weeks he noticed that he has to get up several times during the night to be able to breath. He proudly tells you that he had never visited a doctor before although he smokes and drinks every night.
On physical examination, there is displaced point of his maximum impulse, rales over both lungs and enlarged liver. Echo shows both right and left ventricular dilation and EF 30%. Laboratory test are normal except high bilirubin, AST 245 and ALT 180.
What is the initial cause of this patient presentation?
A- Smoking
B- Alcohol
C- Lyme disease
D- Chronic hypertension
E- High cholesterol
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