COPD USMLE Step 1 Practice Question
A 59-year-old male smoker with COPD (FEV1 32% predicted) presents with acute severe left shoulder pain radiating down the medial arm. Vital signs: BP 158/92, HR 104, RR 22, SpO2 88% on home oxygen. Examination reveals ipsilateral ptosis, miosis, and anhidrosis. Chest X-ray shows left apical opacity. He denies recent trauma or chest tube placement. Which of the following is the most likely location of the underlying lesion?
Answer choices
- ALower lobe adjacent to the diaphragm
- BMainstem bronchus near the carina
- CPosterior mediastinum adjacent to the esophagus
- DPleural space surrounding the entire lung
- ESuperior pulmonary sulcus at the lung apexCorrect answer
- FAnterior mediastinum adjacent to the great vessels
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