question: Q:A 57-year-old man comes to the physician because of tiredness and dyspnea on exertion for several months. Recently, he has also noticed changes of his fingernails. A photograph of his nails is shown. Which of the following is the most likely underlying cause of these findings?? 
  {'A': 'Iron deficiency anemia', 'B': 'Herpetic whitlow', 'C': 'Psoriasis', 'D': 'Dermatophyte infection', 'E': 'Infectious endocarditis'},