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A 48-Year-Old Man Comes to the Office Due to Progressive

question 924

Multiple Choice

A 48-year-old man comes to the office due to progressive weakness for the past 2 months. The patient has experienced difficulty climbing stairs, especially when carrying heavy items such as groceries, and his symptoms have become progressively worse. He also reports occasional fevers, but no significant pain in the muscles or joints. The patient has had no diplopia, dyspnea, dysphagia, abdominal pain, or heat or cold intolerance. He has a history of hypertension and hyperlipidemia, for which he has taken losartan and atorvastatin, respectively, for the last 4 years. The patient does not use tobacco, alcohol, or illicit drugs. Temperature is 37.1 C (98.8 F) , blood pressure is 132/84 mm Hg, pulse is 72/min, and respirations are 14/min. He has no scleral icterus. Cardiopulmonary examination is normal. The abdomen is soft and nontender with no hepatosplenomegaly. Muscle strength is 3/5 in the deltoids and hip flexors but is otherwise normal. Deep tendon reflexes are normal and symmetric, and sensations to pain and light touch are intact. There is mild muscle tenderness and some of the small joints of both hands are tender to palpation without any swelling or erythema. He has no skin rash. Laboratory results are as follows:

Which of the following is the most likely cause of this patient's current symptoms?

Definitions:

Employee Salaries

The monetary compensation paid to employees for their labor, typically on a monthly or yearly basis.

Net Operating Income

The total profit of a company after operating expenses are subtracted from gross profit, but before income taxes and interest are deducted.

Flexible Budget

A budget that adjusts or flexes with changes in the volume or activity levels, allowing for more accurate budgeting in variable cost areas.

Spending Variance

The difference between the actual spending and the budgeted or planned amount, often examined to manage and control expenses.