A 32-year-old male, who recently moved to the area, presents to clinic for the first time for a routine checkup. PMH is significant for type 2 diabetes. He is 5 ft 9 in and weighs 215 lb. The only medication he takes is metformin. He smokes half a pack of cigarettes a day; does not drink alcohol; and exercises sporadically, approximately once every 2 weeks. His mother died at the age of 62 years due to an MI. His father is 73 years of age and is healthy. Physical examination is normal. Vital signs are: BP 146/95, pulse 73, RR 19, temperature 98.2°F. Which of the following lifestyle modifications has been shown to result in the greatest reduction in blood pressure?Ask StudybuddyGroup of answer choicesDecreasing alcohol consumptionSmoking cessationDietary Approaches to Stop Hypertension (DASH) dietIncreasing exerciseWeight loss

complaining of excessive urination and constant hunger and thirst. She has no other complaints and no past medical history. Her family history is significant for hypertension, type 2 diabetes mellitus, and hyperlipidemia. She does not smoke but lives a sedentary lifestyle. On examination, she is afebrile with a blood pressure of 134/88 mmHg, heart rate of 84 beats per minute, and respiratory rate of 14 breaths per minute. The rest of her examination is normal. The patient is scheduled for a return visit to have fasting laboratory tests drawn. At her return visit, her blood pressure is 138/86 mmHg. Her fasting glucose is 156 mg/dL, and urine albumin-to-creatinine ratio is 200 mg/g. What is the next step in management for this patient?

A 49-year-old man presents for routine physical examination. The patient has no active complaints today other than occasional constipation and increased frequency of urination. The patient reports that he has a diagnosis of “pre-diabetes” given to him by his previous physician in another city. His family history is significant for hypertension. The patient denies alcohol or drug use and works as a long-distance truck driver. Physical examination is unremarkable except for a body mass index of 31 kg/m2. The patient's fasting laboratory values reveal the following.Hemoglobin A1c 7.9%Serum glucose 170 mg/dLTotal cholesterol 220 mg/dLLow-density lipoprotein (LDL) 145 mg/dLTriglycerides 130 mg/dLHigh-density lipoprotein 38 mg/dL Which of the following is the best next step in the management of this patient?Ask StudybuddyGroup of answer choicesSulfonylureaLifestyle modificationNiacin, fish oil, and lifestyle modificationAtorvastatin and lifestyle modification

A 51-year-old woman comes to the office because of fatigue and progressive exertional dyspnea during the past several months. She has not had fever, cough, chest pain, palpitations, or weight loss. She has a history of type 2 diabetes mellitus and hyperlipidemia and takes glyburide and simvastatin. Screening colonoscopy 1 year ago showed no abnormalities. The patient does not smoke cigarettes, drink alcohol, or use illicit drugs. BMI is 32 kg/m2. Her temperature is 37.0°C (98.6°F), pulse is 92/min, respirations are 12/min, and blood pressure is 115/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. Physical examination shows mucosal and conjunctival pallor. The lungs are clear to auscultation. Cardiac examination discloses no murmurs. The abdomen is nontender to palpation. No peripheral edema is noted. Laboratory studies show:Hemoglobin 8.8 g/dLMean corpuscular volume 79 μm3Leukocyte count 6,300/mm3Platelet count 210,000/mm3Reticulocyte count 0.4%Hemoglobin A1c 7.8%Serum   Sodium 140 mEq/L   Potassium 4.3 mEq/L   Creatinine 0.9 mg/dL   Thyroid-stimulating hormone 1.2 μU/mLTest of the stool for occult blood is negative. Chest x-ray shows no abnormalities. Which of the following is the most likely underlying pathophysiology causing anemia in this patient?A. Acquired inhibition of aminolevulinic acid synthaseB. Immune-mediated hemolysisC. Increased erythrocyte recycling by macrophagesD. Intermittent nocturnal hypoxemiaE. Release of inflammatory cytokines

Jean is your 78-year-old patient with type II diabetes and a history or coronary artery disease. Her physician is worried that she may be developing hypertension. Which of the following vital signs would indicate this?

A 20-year-old man comes to the physician for evaluation of a murmur that was discovered on a routine physical examination. The patient has no discomfort and has not had chest pain, palpitations, dyspnea, exercise intolerance, or syncope. He has no history of chronic illness. He is a college basketball player and exercises regularly. He takes no medications. He says he sometimes smokes marijuana and drinks alcoholic beverages socially on the weekends. His uncle died while playing soccer at age 26 years. Pulse is 65/min, respirations are 12/min, and blood pressure is 117/77 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. Physical examination shows clear breath sounds, no jugular venous distention, and no lower extremity edema. Cardiac auscultation discloses a faint systolic murmur heard along the lower left sternal border with the patient in the supine position. Upon standing, a grade 3/6 systolic, crescendo-decrescendo murmur is heard in the same location. Which of the following is most likely contributing to the presence of this patient's cardiac murmur?A. Abnormal opening between the left and right ventriclesB. Calcification of the aortic valveC. Dilation of the tricuspid valve annulusD. Prolapse of the mitral valve leafletE. Systolic anterior motion of the mitral valve