A 57-year-old man presents to his physician with dyspnea on exertion and rapid heartbeat. He denies any pain during these episodes. He works as a machine operator at a solar panels manufacturer. He has a 21-pack-year history of smoking. The medical history is significant for a perforated ulcer, in which he had to undergo gastric resection and bypass. He also has a history of depression, and he is currently taking escitalopram. The family history is unremarkable. The patient weighs 69 kg (152 lb). His height is 169 cm (5 ft 7 in). The vital signs include: blood pressure 140/90 mm Hg, heart rate 95/min, respiratory rate 12/min, and temperature 36.6℃ (97.9℉). Lung auscultation reveals widespread wheezes. Cardiac auscultation shows decreased S1 and grade 1/6 midsystolic murmur best heard at the apex. Abdominal and neurological examinations show no abnormalities. A subsequent echocardiogram shows increased left ventricular mass and an ejection fraction of 50%. Which of the options is a risk factor for the condition detected in the patient?
AHistory of gastric bypass surgery
BExposure to heavy metals
CEscitalopram intake
DThe patient’s body mass
ESmoking
A 41-year-old man presents to his primary care provider because of chest pain with activity for the past 6 months. Past medical history is significant for appendectomy at age 12 and hypertension, and diabetes mellitus type 2 that is poorly controlled. He takes metformin and lisinopril but admits that he is bad at remembering to take them everyday. His father had a heart attack at 41 and 2 stents were placed in his heart. His mother is healthy. He drinks alcohol occasionally and smokes a half of a pack of cigarettes a day. He is a sales executive and describes his work as stressful. Today, the blood pressure is 142/85 and the body mass index (BMI) is 28.5 kg/m2. A coronary angiogram shows > 75% narrowing of the left anterior descending coronary artery. Which of the following is most significant in this patient?
AObesity
BFamily history
CHypertension
DSmoking
EDiabetes mellitus
A 5-year-old non-verbal child with a history of autism is brought into the emergency department by his grandmother. The patient’s grandmother is concerned her grandchild is being abused at home. The patient lives in an apartment with his mother, step-father, and two older brothers in low-income housing. The department of social services has an open case regarding this patient and his family. The patient is afebrile. His vital signs include: blood pressure 97/62 mm Hg, pulse 175/min, respiratory rate 62/min. Physical examination reveals a malnourished and dehydrated child in dirty and foul-smelling clothes. Which one of the following people is most likely abusing this patient?
AMother
BNeighbor
CBrother
DStranger
EStep-father
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