OSCE pearl

This 29 years old Malay man presented with the history of shortness of breath for 6/52 duration. The SOB is sudden in onset lasting for 5 minutes but later on become progressive. He could not lying flat but did not waking up at night suddenly due to SOB.

1) Outline your obeservation in this picture

2) What is your differential diagnosis based on the picture.

3) What other history you would like to elicit

4) What other test you would like to perform