A 78-Year-Old Man Is Brought to the Emergency Department with Abdominal

question 2

Multiple Choice

A 78-year-old man is brought to the emergency department with abdominal pain.  According to his wife, he has had epigastric discomfort for the past 2 days; this morning he refused to get out of bed and appeared confused.  Past medical history is significant for diet-controlled diabetes mellitus, coronary artery disease with stable angina, hypertension, and gastroesophageal reflux disease.
On examination, the patient is lethargic.  His temperature is 38 C (100.4 F) , blood pressure is 144/90 mm Hg, pulse is 112/min and irregular, and respirations are 20/min.  Chest is clear on auscultation.  There are no heart murmurs.  The abdomen is tender to palpation in the epigastric and right upper quadrant areas.  His skin is warm and there are no rashes.
Laboratory results are as follows:

ECG reveals atrial fibrillation with no significant ST segment or T wave changes.  Abdominal ultrasound shows several small gallstones without wall thickening or edema around the gallbladder.  Common bile duct size is normal.
Which of the following is the best next step in managing this patient?

• A)Cholecystostomy
• B)Cholescintigraphy
• C)CT angiography of the abdomen
• D)Direct current cardioversion
• E)Transesophageal echocardiogram

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Definitions:

CO₂

Carbon dioxide, a colorless gas produced by burning carbon and organic compounds and by respiration. It is absorbed by plants in photosynthesis.

Vasoconstriction

The narrowing of blood vessels, which increases blood pressure by reducing the volume or space inside the vessels.

Respiratory Centers

Brain regions that regulate the rate and depth of breathing, located primarily in the medulla oblongata and pons.

Central Nervous System

Consists of the brain and spinal cord, responsible for processing information and controlling the body's actions and reactions.