A 70-Year-Old Man Comes to the Physician Due to Generalized

question 515

Multiple Choice

A 70-year-old man comes to the physician due to generalized weakness and headaches.  He has also had intermittent episodes of blurry vision and a 6.8-kg (15-lb) weight loss over the past 3 months.  His other medical problems include hypertension, congestive heart failure, type 2 diabetes mellitus, and hypercholesterolemia.  The patient underwent coronary artery bypass surgery for triple-vessel disease 4 years ago.  His medications include insulin detemir, ramipril, simvastatin, low-dose aspirin, metoprolol, furosemide, and naproxen as needed for headaches.
The patient's temperature is 37.2 C (99 F) , blood pressure is 140/90 mm Hg, and pulse is 73/min.  Eye examination is normal.  He has decreased breath sounds at the left lung base.  The liver edge is palpable at the costal margin.  There is no adenopathy.  There is trace peripheral edema bilaterally.  The prostate is mildly enlarged, soft, and nontender on rectal examination.  Fecal occult blood testing is negative.
Laboratory results are as follows:

Chest x-ray reveals cardiomegaly and a left-sided pleural effusion <1 cm.  Which of the following is the most appropriate next step in management of this patient?

• A)Glucocorticoids
• B)Hemochromatosis gene testing
• C)Prostate-specific antigen test and bone scan
• D)Thoracentesis
• E)Triple-phase abdominal CT

---

Definitions:

Erectile Difficulties

Challenges or inability to achieve or maintain an erection suitable for sexual intercourse, also known as erectile dysfunction.

Diabetes

A chronic medical condition where the body is unable to properly process glucose, leading to high blood sugar levels.

Alcoholism

A severe form of alcohol abuse characterized by an inability to manage drinking habits and a high or compulsive dependence on alcohol.

Erectile Disorder

A sexual dysfunction characterized by the consistent inability to maintain an erection sufficient for satisfactory sexual activity.