A 67-Year-Old Man Comes to the Physician for Fatigue and Lower-Extremity

question 277

Multiple Choice

A 67-year-old man comes to the physician for fatigue and lower-extremity edema.  Seven months ago, he underwent coronary artery bypass graft surgery and mitral valve repair.  His postoperative course has been complicated by paroxysmal atrial fibrillation that is treated with amiodarone and anticoagulation.  He also has diet-controlled type 2 diabetes mellitus.  The patient is a former smoker with a 35-pack-year history.  His blood pressure is 132/77 mm Hg and pulse is 102/min.  Jugular venous pressure is estimated at 16 cm H₂O.  Cardiac auscultation shows a mid-diastolic murmur.  Lungs are clear to auscultation.  There is significant ascites and bilateral lower-extremity edema.  Electrocardiogram shows sinus tachycardia.  Echocardiogram shows enlarged atria, normal left ventricular wall thickness and right ventricular size, and left ventricular ejection fraction of 65%.  There is mild mitral regurgitation.  Chest x-ray shows normal heart size, clear lung fields, and spotty calcifications along the left heart border.  Which of the following is the most likely cause of this patient's symptoms?

• A)Amiodarone toxicity
• B)Cardiac amyloidosis
• C)Constrictive pericarditis
• D)Graft closure
• E)Superior vena cava syndrome

Grasp the concept of muscular involvement in the movement of joints (e.g., knee, hip, ankle).

Identify muscles that do not conform to general function trends within their muscle groups.

Recognize the types of joints associated with the hip and their functional implications.

Understand the basic principles and tools used to measure muscle activity.

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Definitions:

Economic Stress

A condition or situation characterized by financial strain, uncertainty, or hardship affecting individuals, families, or communities, often due to external economic factors.

Nuclear Family

A family group consisting of two parents and their children (biological or adopted), considered the basic unit of society.

Feral

Animals or plants that have returned to a wild state after being domesticated or cultivated.

Teknonymy

A form of naming convention wherein parents are referred to by the names of their children.