Solved

A 35-Year Old Man Comes to the Physician Because of Dyspnea

question 873

Multiple Choice

A 35-year old man comes to the physician because of dyspnea on exertion over the last 3-4 months. The dyspnea is more prominent when he plays tennis. He has no symptoms at rest. He denies chest pain, palpitations, or leg swelling. His other medical problems include chronic low back pain and gastroesophageal reflux disease. He has had local corticosteroid injections due to frequent left heel pain. His current medications include ranitidine and ibuprofen daily, and occasional acetaminophen/codeine for back pain.
His blood pressure is 120/55 mm Hg, pulse is 56/min, and respirations are 12/min. He is in no acute distress. The lungs are clear to auscultation bilaterally. His apical impulse is slightly displaced both inferiorly and laterally. There is a normal S1 and S2. An early decrescendo diastolic murmur is heard best at the left upper sternal border. A third heart sound is present. His pulses are 3+ and symmetric. There is no peripheral joint inflammation or tenderness; range of motion is normal. There are no skin rashes.
Chest x-ray shows normal lung fields, a moderately enlarged cardiac silhouette, and widening of the mediastinum. The chest CT shows a dilated aortic root (4.4 cm) without evidence of dissection.
Which of the following is the most likely diagnosis?

Identify the responsibilities of employers and employees in the payroll tax process.

Understand the treatment of different types of payments and benefits in payroll taxes.

Grasp the implications of payroll tax withholding for employees with multiple income sources or employment statuses.

Recognize the components and purpose of forms related to payroll taxes.

Definitions:

Educational Screening

The process of evaluating academic or psychological qualities to determine the most appropriate educational path or interventions for students.

Professional Positions

Employment roles that require specialized knowledge and often advanced education, including careers in fields such as medicine, law, and engineering.

Head Start Graduates

Refers to individuals who have completed the Head Start program, a U.S. initiative aimed at enhancing the cognitive and social development of children from low-income families.

Cognitive

Related to the process of knowing, understanding, and perceiving things through thought, experience, and the senses.