A 62-Year-Old Man Comes to the Emergency Department with 2

question 151

Multiple Choice

A 62-year-old man comes to the emergency department with 2 episodes of retrosternal pressure-like chest pain over the last 6 hours.  Medical history is significant for type 2 diabetes mellitus, hypertension, and end-stage renal disease.  He undergoes hemodialysis 3 times a week through a left arm arteriovenous fistula.
Blood pressure is 152/89 mm Hg and pulse is 88/min.  The chest is clear on auscultation.  There are no heart murmurs.
Bedside finger-stick glucose level is 134 mg/dL.  ECG shows normal sinus rhythm with 1-mm horizontal ST-segment depressions in leads II, III, aVF, and V4-V6.  The initial troponin I level is 1.5 ng/mL (normal: <0.01) .
He is treated with aspirin.
Which of the following is the most appropriate additional treatment for this patient?

• A)Amlodipine
• B)Enoxaparin
• C)Eptifibatide
• D)Metoprolol
• E)Spironolactone

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Definitions:

Green Algae

A diverse group of photosynthetic organisms found in various aquatic environments, considered important precursors to land plants and characterized by green chlorophyll pigments.

Brown Algae

A group of photosynthetic, multicellular marine algae, including many seaweeds, in the class Phaeophyceae.

Malaria

A life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes.

Plasmodium

A genus of parasitic protozoa that causes malaria in humans and other animals, transmitted by the bite of infected Anopheles mosquitoes.