A 45-year-old woman presents to the clinic complaining of progressive shortness of breath and a persistent dry cough over the past 6 months. She also reports that her fingers often turn white and numb when exposed to the cold, and she has noticed that her hands feel “puffy” and stiff in the mornings. She complains of diffuse muscle achiness and weakness, particularly when climbing stairs. Additionally, she experiences frequent heartburn and a sensation of food getting “stuck” in her chest. Her past medical history is unremarkable, and she takes no regular medications. She is a non-smoker and has no known occupational exposures to lung toxins. She appears well-nourished but mildly uncomfortable. She is afebrile. Her blood pressure is 118/76 mmHg with a heart rate of 82 bpm, a respiratory rate of 18/min, and an oxygen saturation of 94% on room air.