A 54-Year-Old Man Comes to the Physician with Fatigue and Decreased

question 159

Multiple Choice

A 54-year-old man comes to the physician with fatigue and decreased exercise tolerance over the last 6 months.  He denies cough, chest pain, syncope, or weight loss.  He had aortic valve replacement with a mechanical valve due to bicuspid aortic valve stenosis 7 years ago.  Coronary angiography prior to surgery showed no evidence of coronary artery disease.  His medications include warfarin and antacids for occasional heartburn.
His blood pressure is 122/70 mm Hg and pulse is 89/min and regular.  Jugular venous pressure is estimated at 9 cm H₂O.  A faint early diastolic murmur is heard at the left sternal border.  Lungs are clear on auscultation.  The liver span is 9 cm, and the tip of the spleen is not palpable.  There is no edema of the lower extremities.
Laboratory results are as follows:

Which of the following is the most likely diagnosis?

• A)Colonic angiodysplasia
• B)Hemolytic anemia
• C)Large-vessel vasculitis
• D)Lymphoma
• E)Staphylococcus aureus endocarditis

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Definitions:

Transferor

The entity or person that transfers assets, obligations, or rights to another party.

Allowance Method

An accounting technique that estimates and deducts accounts receivable that are not expected to be collected to better represent net realizable values.

Uncollectible Accounts

Accounts receivable that are deemed to be uncollectible, leading to their removal from the accounts through a write-off process.

Write Off

The accounting action of declaring that an asset is partially or completely worthless.