A 45-Year-Old Man Comes to the Emergency Department Due to Shortness

question 657

Multiple Choice

A 45-year-old man comes to the emergency department due to shortness of breath.  His symptoms began when he woke up today and have not diminished since.  The patient also reports mild chest pressure but has no cough, fever, wheezing, or chest pain.  He was diagnosed with idiopathic membranous nephropathy 6 months ago during evaluation of anasarca, and cyclophosphamide and prednisone therapy were begun due to persistent heavy proteinuria.  The patient is a lifelong nonsmoker and does not use alcohol or illicit drugs.
Temperature is 37.2 C (99.0 F) , blood pressure is 144/84 mm Hg, pulse is 112/min and regular, and respirations are 18/min.  Oxygen saturation is 91% while breathing ambient air.  There is no jugular venous distension.  The lungs are clear on auscultation, and cardiac examination shows no abnormalities with the exception of tachycardia.  The patient has 2+ bilateral, lower extremity pitting edema.  There is no calf tenderness.
Laboratory results are as follows:
ECG shows sinus tachycardia with nonspecific ST-T changes.
Which of the following conditions is most likely associated with this patient's current symptoms?

• A)Drug-associated pulmonary toxicity
• B)Occlusion of the right coronary artery
• C)Rapid accumulation of pericardial fluid
• D)Stenosis of the renal arteries
• E)Thrombosis of the renal veins

---

Definitions:

Alcohol Abusers

Individuals who consume alcohol in a manner that is harmful to themselves or others, often leading to addiction or health problems.

Social Learning Model

A theory that suggests people learn new behaviors through observation and imitation of others, rather than through direct experience.

Positive Reinforcement

Adding a positively valued stimulus to a situation, thereby strengthening the behavior it follows.

Modeling

The process of learning or teaching by imitating the behavior of others.