Chronic obstructive pulmonary disease Quiz: Ace Your Exams

A 63-year-old woman presents to the primary care clinic with a 6-month history of progressive shortness of breath, productive cough with white sputum, and intermittent wheezing. Her shortness of breath is worse with activity, but unchanged with lying flat. She denies fever, chills, or night sweats. Her past medical history is significant for hypertension. She has a 35-pack-year smoking history. Temperature is 37.1°C (98.8°F), blood pressure is 129/78 mmHg, pulse is 90/min, respiratory rate is 22/min, and oxygen saturation is 92% on room air. Physical examination is significant for diminished breath sounds bilaterally. She also has mild bilateral pedal edema. A chest radiograph reveals the findings below. Which of the following is the most likely diagnosis?
 
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