A 43-year-old male presents to your office with a 3-day history of chest pain, which is centrally located and radiates to the right side of his neck. The pain worsens with deep breathing and improves when he sits up. He has no nausea, vomiting, sweating, or SOB. He had an upper respiratory infection about 2 weeks ago, which resolved without treatment. PMH is significant for hyperlipidemia. He takes rosuvastatin. He smokes half a pack of cigarettes a day. Vital signs are: temperature 99.4°F, BP 125/80 mm Hg, pulse 84. Physical examination is significant for a friction rub over the left sternal border heard best when he leans forward. A 12-lead ECG shows diffuse ST elevation in leads I, II, III, aVL, and V2 through V6. Echocardiogram shows an EF 50% with no regional wall motion abnormalities and normal valvular function. There is a small pericardial effusion. What is the most appropriate next step?

A 59-year-old female presents to the office because she is “sick and tired” of this cough she has had for 5 years, and it is getting worse. The cough is often productive of watery mucus. She is also becoming increasingly short of breath and cannot climb a flight of stairs without taking a rest. She does not have chest pain, paroxysmal nocturnal dyspnea, fevers, chills, or weight loss. PMH is significant for HTN and a 35-pack-year history of cigarette smoking. Vital signs are as follows: Temperature = 99.0°F, HR 75, RR 21, BP 158/82 mm Hg. O2 saturation is 94% at rest and reaches a nadir of 90% with activity. Physical examination reveals an obese woman in no acute distress. On lung auscultation, there are coarse breath sounds bilaterally but no wheezes or crackles. Chest radiograph is significant for prominent lung markings at the bases. PFTs show FEV1/FVC ratio 0.60 and FEV1 65%.What is the most effective long-term intervention for this woman?Ask StudybuddyGroup of answer choicesAzithromycinSalmeterol inhalerSmoking cessationOxygen therapyTiotropium inhaler

A 45-year-old man comes to the emergency department due to a 1-day history of constant upper abdominal pain, nausea, and several episodes of vomiting.  The pain is partially relieved by sitting up or bending forward.  He has also had mild shortness of breath.  The patient's other medical history includes hyperlipidemia and hypertension.  He uses tobacco and alcohol.  There is a family history of coronary artery disease and hypertension.  Temperature is 38.1 C (100.6 F), blood pressure is 110/70 mm Hg, pulse is 114/min, and respirations are 22/min.  There is dullness to percussion and decreased breath sounds at the left lung base.  Abdominal examination shows epigastric tenderness.  Laboratory results are as follows:Hematocrit 44%Leukocytes 16,000/mm3Calcium 7.8 mg/dLGlucose 250 mg/dLWhich of the following plays a principal role in initial management of this patient's current condition? A.Antiplatelet agents B.Broad-spectrum antibiotics C.Calcium gluconate D.Exploratory laparotomy E.Insulin infusion F.Isotonic crystalloids G.Proton pump inhibitors

A 32-year-old man comes to the physician complaining of fever, shortness of breath, and a productive cough that has developed slowly over the past week. He has no other medical history and does not take any medications. His temperature is 38.5°C, blood pressure is 122/78 mmHg, heart rate is 68 beats per minute, respiratory rate is 18 breaths per minute, and oxygen saturation is 98% on room air. There are decreased breath sounds and dullness to percussion over the right lung base. The rest of the physical examination, including cardiac auscultation, is normal. A chest x-ray confirms consolidation of the right lower lobe. What is the most appropriate course of action for this patient?

A 68-year-old male with a history of lung cancer undergoes follow-up labs after recent cycle of chemotherapy. He has mild difficulty with concentration over the past week but is otherwise able to complete all of his daily tasks. He reports no nausea, vomiting, or positional lightheadedness. He has no other significant past medical history. He takes no medications. Vital signs are as follows: Temperature 99.8°F, RR 18, BP 135/88 mm Hg, pulse 76. On examination, he is alert and oriented. Cardiac examination reveals regular rate and rhythm, no murmurs, JVP not elevated. Lung and abdominal examinations are normal. There is no lower extremity edema. Skin turgor is normal. Neurologic examination reveals 5/5 strength in all extremities, no focal deficits, and normal gait. Laboratory tests reveal the following: serum Na+ 121 mEq/L, K+ 4.3 mEq/L, BUN 7.0 mg/dL, Cr 0.4 mg/dL, glucose 106 mg/dL. TSH 2.0 mU/L. Serum osmolality 250 mOsm/kg, urine Na 45 mEq/L, urine osmolality 450 mOsm/kg. What is the most appropriate management of this patient?

A 66-year-old man comes to the emergency department with significant pain in the right leg.  He says, "The pain started yesterday; I tried resting and taking acetaminophen, but it did not go away."  Medical history includes coronary artery disease with a previous anterior wall myocardial infarction, heart failure with reduced ejection fraction, hypertension, and hyperlipidemia.  The patient does not adhere regularly to prescribed medications.  He does not smoke cigarettes or consume alcohol.  The patient appears to be in moderate discomfort due to pain.  Temperature is 36.7 C (98.1 F), blood pressure is 150/90 mm Hg, pulse is 102/min and regular, and respirations are 14/min.  On physical examination, the right lower extremity appears pale and cooler than the left.  On palpation, no pulses can be appreciated at the right popliteal and dorsalis pedis arteries, but they are detected on Doppler examination.  Sensory and motor examination is unremarkable.  Intravenous heparin infusion is initiated.  Which of the following is the best next step in management of this patient?