Medical | Health | Anatomy on Instagram: "A 68-year-old man with a 50-year history of smoking (80 pack-years) comes in with progressive shortness of breath, unintentional weight loss, and difficulty sleeping unless propped up on two pillows. He reports worsening symptoms on exertion. On physical exam: • Barrel-shaped chest indicating chronic lung changes • Vesicular breath sounds on auscultation • Paradoxical movement of the lower ribs during inspiration (Hoover’s sign) • Oxygen saturation: 89%