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A 54-Year-Old Man Comes to the Emergency Department Due to Several

question 192

Multiple Choice

A 54-year-old man comes to the emergency department due to several hours of left upper quadrant pain, which is constant and worsens with deep inspiration. The patient came to the emergency department a week ago due to fatigue and low-grade fevers for the past month. Blood cell counts, chest x-ray, and urinalysis were within normal limits, and the patient was discharged home with symptomatic treatment. He has had no cough, shortness of breath, vomiting, or diarrhea but reports a 4.5-kg (10-lb) weight loss over the past month. Medical history includes hypertension, osteoarthritis, and a "heart murmur." The patient is a smoker with a 30-pack-year history, drinks alcohol occasionally, and does not use illicit drugs. He is a livestock farmer in rural Pennsylvania and recently returned from a hunting trip.
Temperature is 38.4 C (101.1 F) , blood pressure is 136/72 mm Hg, pulse is 90/min, and respirations are 16/min. The lungs are clear on auscultation. Heart sounds are normal, and a 2/6 early diastolic murmur is present at the right upper sternal border. The abdomen is tender in the left upper quadrant with no guarding or rebound tenderness.
Laboratory results are as follows:
ECG shows sinus rhythm with nonspecific ST- and T-wave changes. CT scan of the abdomen reveals multiple splenic infarcts. Three sets of blood cultures obtained during the previous emergency department visit reveal no growth. Which of the following is the best next step in management of this patient?

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Definitions:

Young People

Refers to individuals in their late childhood to early adulthood, often considered in terms of their potential for growth, learning, and engagement with society.

Marginally

To a minimal extent; slightly or barely meeting a requirement or standard.

Ethical

Relating to morals, it describes actions or behaviors that are considered right, fair, and in accordance with accepted principles of conduct.

Women

Refers to the adult female human beings, but in many contexts, it pertains to issues specifically related to their rights, representation, and experiences in society.