A 64-Year-Old Man Comes to the Office Due to Progressive

question 122

Multiple Choice

A 64-year-old man comes to the office due to progressive fatigue and weakness over the past several months.  The patient says, "I have very little energy and can hardly walk a block without resting."  He has had no chest pain, palpitations, or dyspnea at rest but has had mild breathlessness while walking.  His wife adds that he has lost his appetite, and she believes that he has lost some weight.  The patient was diagnosed with hypertension several years ago but does not take any medications.  He drinks a half-pint of whiskey a day.  Blood pressure is 148/86 mm Hg, pulse is 80/min, and respirations are 14/min.  Oxygen saturation is 98% while breathing ambient air.  Lung auscultation is normal and heart sounds are normal with no murmur.  The abdomen is nondistended, soft, and nontender on palpation.  Rectal examination shows occult blood-positive brown stool.  Laboratory results are as follows: Which of the following is the best initial step in evaluation of this patient's anemia?

• A)Bone marrow biopsy
• B)Colonoscopy
• C)Erythropoietin level
• D)Esophagogastroduodenoscopy
• E)Tagged red blood cell scan

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Definitions:

DC Motor

An electric motor that runs on direct current (DC) electricity, converting electrical energy into mechanical energy through the rotation of a shaft.

Magnetic Field

A vector field surrounding magnets, electric currents, and changing electric fields, where magnetic forces are exerted.

Armature

The rotating part of an electric machine (motor or generator) within which a current is induced by a magnetic field.

Brushless DC

A type of direct current electric motor (DC motor) that uses an electronic controller to switch the current in the motor, eliminating the need for brushes.