A 54-year-old man is brought to the emergency department after his family found him on the floor and unresponsive at home.  The patient has a history of hypertension but is not adherent with medical treatment.  He smokes cigarettes and uses cocaine.  Temperature is 36.6 C (97.9 F), blood pressure is 176/98 mm Hg, pulse is 58/min, and respirations are 12/min and irregular.  The patient is unresponsive to deep sternal rub.  The right pupil is widely dilated and unresponsive to light.  There is intermittent extended posturing of the left arm and leg.  Deep tendon reflexes are 4+ in the left extremities, and Babinski sign is present on the left side.  Which of the following is the most likely cause of this patient's current condition? A.Basal ganglia hemorrhage B.Cerebellar hemorrhage C.Medullary ischemic infarction D.Midbrain ischemic infarction E.Occipital cortex ischemic infarctionProceed To Next Item

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 46-year-old man comes to the office for follow-up due to a blood pressure reading of 150/95 mm Hg during a preemployment examination.  He has had no symptoms, and his medical history is unremarkable.  The patient is an ex-smoker with a 10-pack-year history; he does not use alcohol or illicit drugs.  He has a family history of hypertension, and his father died of a stroke at age 68.  Blood pressure is 145/90 mm Hg (repeat: 144/92 mm Hg), and pulse is 75/min and regular.  BMI is 29 kg/m2.  Physical examination is unremarkable.  This patient should be screened for which of the following conditions?

A 30-year-old man comes to the office for follow-up of hypertension. Two weeks ago, his blood pressure was 160/95 mm Hg when taken at a community health fair. He denies chest pain and headache but has experienced some muscle pain and weakness. He has no significant medical history and does not take any medications. Family history is remarkable for coronary artery disease and hypertension. He does not smoke cigarettes or use illicit drugs. He drinks approximately 2-3 alcoholic beverages monthly. Today, his pulse is 84/min and blood pressure is 152/90 mm Hg. BMI is 24 kg/m2. His mucous membranes are moist. Cardiopulmonary examination is normal. There is no papilledema. Laboratory results show:Serum   Na+ 141 mEq/L   K+ 2.6 mEq/L   Ca2+ 9.3 mg/dLGlucose 82 mg/dLCreatinine 0.9 mg/dLThyroid-stimulating hormone 2.0 μU/mLWhich of the following is the most appropriate next step in the evaluation of this patient?

A 62-year-old man comes to the emergency department due to painless vision loss in his left eye.  The patient states that he was watching television when suddenly everything became dark and he could not see out of his left eye.  This resolved spontaneously after approximately 5 minutes and was not associated with headache, slurred speech, numbness, or weakness.  He experienced a similar episode several months ago, at which time he did not seek medical attention.  His medical history is significant for hypertension, type II diabetes mellitus, and hyperlipidemia; he admits that he is not compliant with his medication regimen.  Two years ago, the patient was hospitalized for hyperosmolar hyperglycemic state, and his HbA1c level 4 months ago was 9.5%.  He has a 30-pack-year smoking history.  Temperature is 36.7 C (98 F), blood pressure is 160/90 mm Hg, and pulse is 80/min and regular.  Which of the following is the most likely cause of this patient's symptoms?

A 36-year-old man comes to the office for a routine visit. He has not seen a doctor in over 15 years, but his wife insisted he go for a “checkup.” He has no medical problems or complaints. He has smoked half a pack of cigarettes for the last 10 years. His vitals show a temperature of 37.2°C, blood pressure of 148/82 mmHg, heart rate of 70 beats per minute, and respiratory rate of 12 breaths per minute. His BMI is 28 kg/m2. Repeat blood pressure measurement shows 152/88 mmHg. His physical examination is unremarkable.Hemoglobin 14.5 g/dLLeukocyte count 7,500/mm3Sodium 139 mEq/LPotassium 4.1 mEq/LCreatinine 0.9 mg/dLRandom blood glucose 98 mg/dL He is counseled on maintaining a healthy diet, exercise, and smoking cessation. What is the best next step in management?