Review Question - QID 110024

A 66-year-old man presents to his primary care provider for a routine checkup. He says that he feels well overall but has experienced some intermittent back pain and vague epigastric pain over the past 6 months. He also has experienced cramping in both legs that is worse whenever he walks for long periods of time. He has a history of poorly controlled hypertension, diabetes mellitus, recurrent renal stones, and major depressive disorder. He takes lisinopril, nifedipine, metformin, glyburide, and fluoxetine. He has a 55-pack-year smoking history and drinks alcohol socially. His temperature is 98.4°F (36.9°C), blood pressure is 155/85 mmHg, pulse is 92/min, and respirations are 16/min. On exam, he is well-appearing and in no acute distress. A normal S1 and S2 are heard on auscultation. He has no abdominal tenderness to palpation. A light pulsatile mass is felt in the mid-epigastrium. Achilles and patellar reflexes are 2+ bilaterally. His gait is normal. Which of the following additional findings is most strongly associated with this patient’s condition?