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A 76-Year-Old Man Comes to the Physician Due to a Several-Week

question 479

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A 76-year-old man comes to the physician due to a several-week history of fatigue and lethargy. He lives in an assisted living facility and takes naps during the day but still feels exhausted in the evening. The patient does not use tobacco or alcohol. His medical problems include hypertension, type 2 diabetes mellitus, coronary artery disease, and ischemic cardiomyopathy. He also underwent coronary artery bypass grafting 5 years ago.
The patient was hospitalized 4 months ago with dizziness, palpitations, and near-syncope and was diagnosed with monomorphic ventricular tachycardia. He underwent electrical cardioversion and was started on amiodarone and high-dose metoprolol. Laboratory workup during that time was unremarkable, and his echocardiogram showed a left ventricular ejection fraction of 25%. An automated implantable cardioverter-defibrillator (AICD) was implanted before discharge. The last device interrogation 4 weeks ago showed multiple episodes of non-sustained ventricular tachycardia but no defibrillator shocks.
His blood pressure is now 140/90 mm Hg and pulse is 62/min and regular. The patient has normal jugular venous pressure. There is no thyromegaly. Lung fields are clear to auscultation. A faint mid-systolic murmur is heard at the left sternal border. There is 1+ peripheral edema bilaterally and his skin is dry. Deep tendon reflexes are diminished bilaterally. Laboratory studies are shown below:
$A 76-year-old man comes to the physician due to a several-week history of fatigue and lethargy. He lives in an assisted living facility and takes naps during the day but still feels exhausted in the evening. The patient does not use tobacco or alcohol. His medical problems include hypertension, type 2 diabetes mellitus, coronary artery disease, and ischemic cardiomyopathy. He also underwent coronary artery bypass grafting 5 years ago. The patient was hospitalized 4 months ago with dizziness, palpitations, and near-syncope and was diagnosed with monomorphic ventricular tachycardia. He underwent electrical cardioversion and was started on amiodarone and high-dose metoprolol. Laboratory workup during that time was unremarkable, and his echocardiogram showed a left ventricular ejection fraction of 25%. An automated implantable cardioverter-defibrillator (AICD) was implanted before discharge. The last device interrogation 4 weeks ago showed multiple episodes of non-sustained ventricular tachycardia but no defibrillator shocks. His blood pressure is now 140/90 mm Hg and pulse is 62/min and regular. The patient has normal jugular venous pressure. There is no thyromegaly. Lung fields are clear to auscultation. A faint mid-systolic murmur is heard at the left sternal border. There is 1+ peripheral edema bilaterally and his skin is dry. Deep tendon reflexes are diminished bilaterally. Laboratory studies are shown below: Which of the following is the best next step in managing this patient? A) Check anti-thyroid peroxidase (anti-TPO) antibodies B) Continue amiodarone and start levothyroxine C) Discontinue amiodarone and repeat thyroid function tests in a few weeks D) Discontinue amiodarone and start levothyroxine E) Order thyroid ultrasound$
Which of the following is the best next step in managing this patient?

Identify the role and format of comments within C code.

Understand how to invoke a function and common terminology associated with it.

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Definitions:

'Emic' Analyses

Cultural studies or analyses that are conducted from within the cultural group, using concepts and categories that are meaningful and relevant to the group itself.

Cross-Cultural Analyses

Comparing and contrasting behaviors, customs, norms, and values across different societies or cultures to understand human behavior in a broader context.

Generic Analyses

Assessments or studies designed to be broadly applicable across different contexts, often without specific customization to a particular scenario.

Social Identity Theory

Theory of group membership and intergroup relations based on self-categorization, social comparison and the construction of a shared self-definition in terms of ingroup-defining properties.