[Answered]: Robert, 58-year-old man, has been a smoker since…

Robert, 58-year-old man, has been a smoker since childhood. He has been smoking three packs per day as long as he can remember but insists his cigarettes “don’t hurt me none, doc.” He has been feeling ill recently, however, with loss of appetite, malaise, and weight loss. His mental ability has been dulled recently, and he can’t remember from “one minute to the next,” especially notable during his work as a cowboy. Robert noted his cigarettes have not been as enjoyable for him as they used to be. He complained of a worsening baseline cough, and he has noticed blood streaking his sputum when he clears his throat. He has no significant past medical history other than his tobacco use. He takes no medications. His family history is only notable for his father dying of lung cancer at age 63 and his mother dying of emphysema at age 68. On physical examination, he is a thin man who looks much older than his chronologic age and appears unwell. When he produces some sputum at the physician’s request, it does indeed have a pink tinge and is streaked with blood. Chest examination reveals some scattered wheezing and some rales in the right upper lung region. He is diffusely weak on muscle strength testing. Presentation: List 5 concerning things in his presentation (signs & symptoms/history/family history)