Review Question - QID 212620

A 64-year-old man presents to the clinic complaining of a cough for the past 2 weeks. He reports that it has been getting worse to the point that sometimes it is difficult for him to breath. He denies any symptoms suggestive of an upper respiratory infection (e.g., runny nose, congestion, or headache), heartburn, palpations, weight loss, or rashes but reports “feeling warm” over the past couple of days. His family history is unremarkable. When asked about his past medical history, the patient claims that he “hasn’t seen a doctor since his thirties.” He denies smoking in the past but endorses drinking “1-2 bottles of something” every night. Physical examination demonstrates halitosis, mild scleral icterus, and skin findings shown in Figure A. No right upper quadrant pain or wheezing were detected. What is the most likely explanation for this patient’s symptoms?