A 78-Year-Old Man Is Brought to the Emergency Department Due

question 233

Multiple Choice

A 78-year-old man is brought to the emergency department due to an episode of syncope while working in his garden.  He is now alert and oriented.  He has chest and neck pain that developed just prior to the syncopal episode.  Over the past week, he has had a cough, chest tightness, and whitish sputum production.  Medical history is significant for long-standing hypertension, hyperlipidemia, and type 2 diabetes mellitus.  The patient is a lifetime nonsmoker.  Temperature is 37.3 C (99.2 F) , blood pressure is 144/92 mm Hg on the right arm and 142/90 mm Hg on the left arm, and pulse is 109/min.  ECG shows sinus tachycardia, voltage criteria for left ventricular hypertrophy, and no ST-segment or T-wave changes.  Chest x-ray is shown in the exhibit.  A bedside transthoracic echocardiogram shows a small pericardial effusion.  Which of the following is the best next step in management of this patient?

• A)Antibiotics, fluid resuscitation, and admission to intensive care unit
• B)Beta blockers, anticoagulation, and admission to intensive care unit
• C)Cardiac catheterization
• D)CT angiography
• E)Immediate emergency pericardiocentesis

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Definitions:

Eye Examination

A series of tests conducted to assess vision and the ability to focus on and discern objects, as well as other tests and examinations pertaining to the eyes.

Pediatrician

A medical doctor specializing in the physical, behavioral, and mental care of children from birth to young adulthood.

Auscultating Heart Sounds

The process of listening to the sounds of the heart using a stethoscope to evaluate its function and detect potential abnormalities.

Aortic Area

The region of the chest where the aorta is located, often assessed during a physical examination to detect abnormalities in the heart's largest artery.