A 78-year-old male with a history of aortic stenosis with a mechanical aortic valve, hypertension, and type 2 diabetes presents to office for evaluation. He is doing well, except for some palpitations over the past few months. He does not have associated shortness of breath, syncope, or a history of falls. On physical examination, you note an irregularly irregular heart rhythm and a mechanical S2. Examination is otherwise normal. You obtain an ECG, which confirms the irregularly irregular arrhythmia. The patient has no history of bleeding and Hgb is normal. What is the recommended medication for prevention of thromboembolic events?Ask StudybuddyGroup of answer choicesWarfarinAspirinClopidogrelDabigatranApixaban

A 73-year-old man with severe aortic stenosis presents to the hospital after passing a moderate amount of blood per rectum. Over the past few years, he has noticed easy bruising and frequent nose bleeds. He has no history of a bleeding disorder, and has no family history of such conditions. He does not take any medications. His vitals are normal, and the examination is unremarkable except for the murmur of aortic stenosis. Laboratory values are drawn and show a hemoglobin level of 11 g/dL and a normal prothrombin time (PT) and partial thromboplastin time (PTT). Factor VIII levels are decreased. What is the most likely explanation for the episodes of bleeding in this patient?Ask StudybuddyGroup of answer choicesDefect in platelet adhesionPlatelet deficiencyClotting factor deficiencyInhibition of antithrombin IIIVitamin K deficiency

A 24-year-old woman comes to the office due to pressure-like, substernal chest pain that occurs when she exercises.  The patient began noticing the pain approximately 6 months ago when she started to exercise to lose weight.  Prior to that, her lifestyle was largely sedentary.  She has no associated nausea, vomiting, diaphoresis, dyspnea, palpitations, or syncope.  The patient has no significant past medical history but was told as a child that she has a "murmur."  She has no significant family history of heart disease.  Blood pressure is 130/70 mm Hg on the right and 105/55 mm Hg on the left, and pulse is 72/min and regular.  BMI is 29 kg/m2.  A palpable thrill is present in the suprasternal notch.  There is a loud midsystolic murmur best heard at the first right intercostal space.  The lungs are clear to auscultation.  What is the most likely cause of this patient's chest pain?

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 38-year-old immigrant woman comes to the Emergency Department with right-sided weakness and slurring of her speech. Initial imaging and studies are obtained, and she is found to have suffered an ischemic stroke and is treated appropriately. When you go to examine her, she has an irregularly irregular pulse, and on cardiac examination she has an early diastolic high-pitched opening snap at the apex followed by a low-pitched diastolic rumbling murmur. Upon further discussion with the family, they indicate that she does not have any chronic medical problems and has not been to the doctor since she was a baby. She had frequent throat infections as a child, but these always resolved without treatment. She takes no medications and does not smoke or drink alcohol. The mechanism by which this condition developed is most similar to which of the following other conditions?Ask StudybuddyGroup of answer choicesGraves diseaseCystic fibrosisGuillain–Barré syndromeSarcoidosisInfective endocarditis

A 45-year-old woman presented with exertional dyspnea. Fourteen years earlier the patient was diagnosed with arterial hypertension with a blood pressure of 170/105 mm Hg. Her blood pressure at presentation was 155/95 mm Hg. Physical examination was remarkable for lower-extremity edema, and abdominal enlargement due to ascites. Transthoracic echocardiogram showed left ventricular ejection fraction of 28% (reference range: 50-57%). Which of the following is the patterns of cardiac failure seen in this patient?