A 56-Year-Old Man Comes to the Physician for an Initial

question 918

Multiple Choice

A 56-year-old man comes to the physician for an initial evaluation.  He reports tiredness and decreased exercise tolerance over the past few weeks.  He feels "out of breath" when he goes ballroom dancing with his wife, which has been a regular activity for them.  He has not had any cough, orthopnea, wheezing, and lower extremity edema.  The patient's other medical problems include gastroesophageal reflux disease.  Approximately a month ago he had a particularly severe episode of burning in the upper abdomen and chest, but he has not noted any dark stools or blood in the stool.  He takes ranitidine intermittently and uses ibuprofen periodically for pain in his left knee but is not taking any regular medications.  He has a 30-pack-year smoking history and drinks 1-2 beers per night.  The patient's mother had diabetes mellitus and died of a stroke.  His father died of colon cancer.  His blood pressure is 144/89 mm Hg and pulse is 94/min and regular.  BMI is 32 kg/m².  Examination shows normal jugular venous pressure and clear lungs.  First and second heart sounds are normal.  Deep palpation in the epigastric region elicits mild tenderness.  Laboratory results are as follows: ECG is shown in the exhibit.  Which of the following is the most appropriate next step in pharmacotherapy?

• A)Fenofibrate
• B)Ferrous sulfate
• C)Ipratropium bromide
• D)Metoprolol
• E)Sucralfate

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Definitions:

Transportation Strategy

Planning and execution related to the movement of goods or services from one location to another, aiming to optimize efficiency and cost.

Rail

A mode of transportation that involves the movement of goods or passengers on trains along a set of tracks.

Carrier

A company or individual that provides transportation services for goods or people.

Straight Bill Of Lading

A document issued by a carrier that specifies the goods being transported are to be delivered to the specified party, without endorsement.