A 21-Year-Old Man Is Seen in the Clinic for a Routine

question 327

Multiple Choice

A 21-year-old man is seen in the clinic for a routine checkup.  He is a cyclist and was asked by his trainer to see a physician due to a "slow heartbeat."  The patient describes intense physical activity in preparation for tournaments and has no symptoms.  Specifically, he has no chest pain, shortness of breath, lightheadedness, presyncope, or syncope.  His family history is unremarkable.  He does not take any medications or use performance-enhancing drugs.  Blood pressure is 123/72 mm Hg and pulse is 46/min.  No cardiac murmurs are heard in the supine or upright positions.  There are no additional heart sounds.  The lungs are clear on auscultation.  Pulses are full and symmetric, and there is no peripheral edema.  ECG shows sinus bradycardia at 48/min.  The PR interval is prolonged at 250 msec, consistent with first-degree atrioventricular block.  QRS complexes are normal with no repolarization abnormalities, and QTc interval duration is normal at 400 msec.  Which of the following is the best next step in management of this patient?

• A)24-hour ECG monitoring
• B)Blood testing for performance-enhancing drugs
• C)Reassurance and routine care
• D)Transthoracic echocardiogram
• E)Treadmill exercise testing

---

Definitions:

Delinquency

Behavior, particularly of a young person, that is illegal or not approved of by society.

Preconventional Morality

The first level of Kohlberg's stages of moral development, where moral reasoning is based on external consequences or rewards.

Stealing

The act of taking someone else's property without permission or legal right and with the intent to deprive the rightful owner of it permanently.

Spank

A form of physical discipline involving striking the buttocks, typically with an open hand to correct or control behavior.