Abstract
A 49-year-old female bank executive presented to Ohio State University Hospitals for a routine physical. She had not seen a physician since her last child was born (age 38) but she was due for a promotion which required a physical examination. She denied any physical complaints. She had a forty pack-year history of smoking. Her past medical history was only remarkable for three pregnancies resulting in healthy term deliveries. She was born and raised in a small town in Ohio but had lived in an urban setting for the past 20 years.
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