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A 54-Year-Old Man Comes to the Emergency Department Due to Worsening

question 434

Multiple Choice

A 54-year-old man comes to the emergency department due to worsening epigastric and retrosternal chest pain, nausea, and vomiting. The patient started having severe nausea, retching, and forceful vomiting after eating some spicy food and consuming a small amount of alcohol with dinner several hours ago. The vomitus contained ingested food particles, but the most recent episode included a small amount of bright red blood. The pain has progressively worsened, and he now has pain while swallowing and mild shortness of breath. The patient has had dyspeptic symptoms in the past, which he self-treated with over-the-counter antacids. He does not use tobacco or illicit drugs. He appears pale, diaphoretic, and in moderate distress. Temperature is 38 C (100.4 F) , blood pressure is 140/90 mm Hg, pulse is 120/min, and respirations are 24/min. Neck veins are flat. Dullness to percussion and decreased breath sounds are present over the left basal area. Abdominal examination reveals epigastric tenderness and decreased bowel sounds. Stool occult blood is positive. Upright chest x-ray reveals a small pleural effusion of the left lung, and ECG shows sinus tachycardia; the imaging results are otherwise unremarkable.
Which of the following is the most likely cause of this patient's current condition?

Definitions:

Socialization

The process by which individuals learn and internalize the norms, values, behaviors, and social skills necessary to function within a society or specific organization.

Internal Recruitment

The process of filling an organization's job vacancies with current employees rather than looking for candidates externally.

Fresh Perspectives

New, innovative viewpoints or ways of considering something, often leading to creative solutions.

Manager Recommendations

Advisories or suggestions given by managers aimed at improving performance, operations, or decision-making within an organization.