Correct!
2. Congestive heart failure
The physical findings are suggestive of congestive heart failure. The chest radiograph shows cardiomegaly and small bilateral pleural effusions, increased reticular interstitial markings, and prominent perihilar vasculature suggestive of pulmonary edema. He was treated with furosemide and clinically improved. He was discharged after 1 day in the hospital.
He was subsequently started on enzalutamide, an antiandrogen, for his progressing prostate cancer due to increased bone metastases. Three months later his prostate specific antigen had increased to 639 ng/mL and he was started on carboplatin.
Approximately 4 months after his first hospitalization, he was admitted again to the hospital due to increasing dyspnea. Oxygen saturation was 93% on 3 lpm by nasal cannula. There was no JVD but chest exam again revealed scattered crackles. There was 1+ pretibial ankle edema.
A chest radiograph was again performed (Figure 2).
Figure 2. Chest x-ray from second admission.
Which of the following is the most appropriate therapy? (Click on the correct answer to proceed to the third of six pages)