The Not-So-Routine Physical

A 60-year-old woman wants to establish care as a new patient at your clinic. She pre­sents for an annual physical and has no current complaints.

Her medical history is significant for hypertension and remote uterine cancer, which was treated with a hysterectomy. She does report smoking a half-pack to one pack of cigarettes per day for “about 30 to 40” years.

Vital signs are normal. Overall, the complete physical examination yields no abnormal findings. Routine bloodwork, 12-lead ECG, and a chest radiograph are ordered. The last is shown. What is your impression?