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Medicine
A 60-year old male has a long 5tanding history of breathlessness lie has been a heavy smoker since the age of 20 years. Physical examination reveals an anxious male who is emaciated, puffing for breath but is not cyanosed. The chest is barrels shaped. An additional clinical finding would be -
Elevated domes of the diaphragm
Left ventricular hyperophy
Muffled hea sounds
Gynecomastia
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