Review Question - QID 214229

A 56-year-old man with a history of hyperlipidemia, hypertension, and diabetes presents to the clinic with shortness of breath. He reports progressively worsening dyspnea beginning 1 week ago. At baseline, the patient walks 10 minutes with his dog but is now only able to take 20 steps before he feels winded. He denies any fevers, lightheadedness, or chills but endorses an upper respiratory tract infection (URI) 1 week ago with some residual cough. The patient works as a long-distance truck driver. He has a 40 pack-year smoking history and drinks occasionally. Medications include lisinopril, aspirin, atorvastatin, and metformin, but the patient reports non-compliance due to his busy schedule. A physical examination demonstrates a well-appearing gentleman with a pulsating bulge at the right neck. What additional physical examination finding is the most likely in this patient?