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A 52-Year-Old African American Man Comes to the Physician Because

question 441

Multiple Choice

A 52-year-old African American man comes to the physician because of foggy vision in both eyes. He denies any headache, nausea, or vomiting. He was diagnosed with extensive cellulitis and osteomyelitis of the right foot 4 weeks ago and has been taking oral linezolid. His other medical problems include sarcoidosis, pulmonary hypertension, lower extremity venous stasis, deep vein thrombosis, type 2 diabetes for 5 years, hypertension, and chronic kidney disease.
His medications include warfarin, prednisone (10 mg/day) , insulin, hydralazine, clonidine, metoprolol, valsartan, and furosemide. He has been compliant with his medication regimen. He quit smoking 7 years ago and denies the use of alcohol or illicit drugs. He is allergic to vancomycin.
His temperature is 36.7 C (98 F) , blood pressure is 150/90 mm Hg, and pulse is 72 /min. His BMI is 32 kg/m². Visual acuity is 20/400 in both eyes with considerable optic disc edema, hyperemia, and reduced color perception. A right carotid bruit is present. Examination shows jugular venous distention, a few fine crackles in all lung fields, normal first and second heart sounds, and a palpable liver 2 cm below the costal margin. Bilateral 1+ pitting lower extremity edema to the mid shin and a resolving right leg cellulitis is present.
Which of the following is the most immediate next step in management?

Definitions:

Develop

To bring out the capabilities or possibilities of something; to make more intricate or evolve, especially over time.

Accumulated Degree Hours

A measure used in forensic entomology to estimate the age of a maggot in a corpse, based on the accumulation of hourly temperatures above a threshold.

Larva

The juvenile form of many animals before undergoing metamorphosis, often differing significantly in form and habit from the adult stage.

Develop

To grow or cause to grow and become more mature, advanced, or elaborate.