A 39-Year-Old Man Comes to the Emergency Department Due to an Episode

question 236

Multiple Choice

A 39-year-old man comes to the emergency department due to an episode of chest pain.  He says, "I had dinner and 2 hours later started to get this discomfort in the middle of the chest.  It felt dull and annoying."  The pain lasted for 2 hours, waxed and waned in intensity, and did not radiate.  The patient did not have any back pain, dyspnea, palpitations, or lightheadedness, and has never had similar pain episodes.  After the pain subsided, his wife insisted that he go to the emergency department.  Currently, he has no pain or discomfort and wants to return home.  The patient does have occasional heartburn and takes over-the-counter antacids.  Medical history is otherwise unremarkable.  The patient has smoked a pack of cigarettes a day for the past 10 years.  He does not drink alcohol or use illicit drugs.  He has no known medication allergies.  His father died suddenly in his sleep at age 55.  His older brother is healthy.  Blood pressure is 138/86 mm Hg and pulse is 89/min and regular.  BMI is 28 kg/m².  There are no heart murmurs or additional sounds.  No carotid bruits are heard.  Abdominal examination is unremarkable.  ECG shows normal sinus rhythm with nonspecific T-wave changes in leads II and III.  Chest x-ray is normal.  Which of the following is the best next step in management of this patient?

• A)Obtain D-dimer level
• B)Obtain troponin I level
• C)Order treadmill exercise stress test
• D)Prescribe lansoprazole and advise outpatient follow-up
• E)Refer for coronary angiography

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Definitions:

Fourteenth Amendment

An amendment to the U.S. Constitution granting citizenship to all persons born or naturalized in the United States, and guaranteeing all citizens equal protection under the laws.

Due Process Clause

A clause in the Fifth and Fourteenth Amendments of the United States Constitution ensuring legal protections and fairness, including the requirement for proper legal procedures and the protection of individual rights.

National Government

The organization through which political authority is exercised at the national level, governing the entirety of a country.

State Governments

These are the governments of the individual states within a federal system, each having its own constitution and the authority to legislate on matters not reserved for the federal government.