A 69-year-old man is brought in by his wife with acute onset aphasia for the past 5 hours. The patient's wife says that they were sitting having dinner when suddenly he was not able to speak. They delayed coming to the hospital because he had a similar episode 2 months ago which resolved within an hour. His past medical history is significant for hypercholesterolemia, managed with rosuvastatin, and a myocardial infarction (MI) 2 months ago, status post percutaneous transluminal coronary angioplasty complicated by residual angina. His family history is significant for his father who died of MI at age 60. The patient reports a 15-pack-year smoking history but denies any alcohol or recreational drug use. The vital signs include: temperature 37.0℃ (98.6℉), blood pressure 125/85 mm Hg, pulse 96/min, and respiratory rate 19/min. On physical examination, the patient has expressive aphasia. There is a weakness of the right-sided lower facial muscles. The strength in his upper and lower extremities is 4/5 on the right and 5/5 on the left. There is also a decreased sensation on his right side. A noncontrast computed tomography (CT) scan of the head is unremarkable. CT angiography (CTA) and diffusion-weighted magnetic resonance imaging (MRI) of the brain are acquired, and the findings are shown in the exhibit (see image). Which of the following is the best course of treatment in this patient?
AAspirin
BMannitol
CMechanical thrombectomy
DIV tPA
ELow molecular weight heparin
A 58-year-old man presents to the clinic concerned about his health after his elder brother recently became bed-bound due to a brain condition. He has also brought a head CT scan of his brother to reference, as shown in the picture. The patient has type 2 diabetes mellitus, hypertension, osteoarthritis, and hypercholesterolemia. His medication list includes aspirin, diclofenac sodium, metformin, and ramipril. He leads a sedentary lifestyle and smokes one pack of cigarettes daily. He also drinks 4–5 cups of red wine every weekend. His BMI is 33.2 kg/m2. His blood pressure is 164/96 mm Hg, the heart rate is 84/min, and the respiratory rate is 16/min. Which of the following interventions will be most beneficial for reducing the risk of developing the disease that his brother has?
AStatin therapy
BQuit smoking
CStop aspirin
DBlood sugar control
EBlood pressure control
A 68-year-old woman is brought to the emergency department by her husband because of acute confusion and sudden weakness of her left leg that lasted for about 30 minutes. One hour prior to admission, she was unable to understand words and had slurred speech for about 15 minutes. She has type 2 diabetes mellitus and hypertension. She has smoked 1 pack of cigarettes daily for 30 years. Current medications include metformin and hydrochlorothiazide. Her pulse is 110/min and irregular; blood pressure is 135/84 mmHg. Examination shows cold extremities. There is a mild bruit heard above the left carotid artery. Cardiac examination shows a grade 2/6 late systolic ejection murmur that begins with a midsystolic click. Neurological and mental status examinations show no abnormalities. An ECG shows irregularly spaced QRS complexes with no discernible P waves. Doppler ultrasonography shows mild left carotid artery stenosis. A CT scan and diffusion-weighted MRI of the brain show no abnormalities. Which of the following treatments is most likely to prevent future episodes of neurologic dysfunction in this patient?
AWarfarin
BEnalapril
CAlteplase
DAspirin
EMitral valve replacement
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