A 68-Year-Old Man Comes for Outpatient Follow-Up After Recent Coronary

question 349

Multiple Choice

A 68-year-old man comes for outpatient follow-up after recent coronary artery bypass grafting surgery.  He describes anterior chest "clicking" and "shifting" when he bends or moves his upper extremities.  The patient has no chest pain, dyspnea, fever, chills, or abdominal pain.  He underwent uncomplicated surgery with internal thoracic artery harvesting 6 days ago for severe coronary artery disease.  The patient is afebrile, and vital signs are within normal limits.  Medical history includes diabetes mellitus, obesity, and chronic obstructive pulmonary disease.  Examination reveals a midsternal wound that is clean with well-approximated sutures and minimal serous discharge at the lower edge but without erythema.  On palpation the sternum appears to be rocking and clicking with patient coughing.  Which of the following is the best management for this patient?

• A)Clinical observation only
• B)Compressive sternal dressing
• C)Negative pressure wound therapy
• D)Oral antibiotics
• E)Surgical exploration and sternal fixation

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Definitions:

Maturational Milestone

significant developmental events or achievements that are typically reached by most individuals at a certain age which reflect physical or cognitive development.

Puberty

The developmental stage in humans and other animals during which a child's body matures into an adult body capable of sexual reproduction.

Positive Self-Image

The perception of oneself in a favorable or affirming manner, often associated with confidence and well-being.

Authoritative

Characterized by an assertive and reasonable approach, especially in leaders, that is often effective in guidance, discipline, and setting standards.