64-year-cid man is assessed for discharge after presenting to the hospital with non-ST elevation myocardial infarction 2 days ago


64-year-cid man is assessed for discharge after presenting to the hospital with non-ST elevation myocardial infarction 2 days ago

He underwent successful percutaneous coronary intervention to the right coronary arteryon the day ofadmission and has been

symptom-free since then. The patient has a history of hypertension and was treated with lisinopril be!Ofe admission. His father

underwent coronary artery bypass grafting at age 65, and his sister has diabetes. The patient drinks a 6-pack of beer most nights. He

does oot use tobacco or illicit drugs Weight is 90 kg (198.4 lb) and height is 17 7.8 cm (5 ft 10 in) BMI is 28.5 kg/m2 Blood pressure

is 14218 9 mm Hg. His dentition is poor The lungs are clear on auscultation. There are no heart murmurs. A faint bruit is heard over

the right carotid artery but there are no periumbilical bruits. Lower extremity pulses are full and there is no peripheral edema. Fasting

laboratory results are as follows

Total cholesterol 3 06mg/dl

HDL 40mg/dl

LDL not calculated

Triglycerides 465mg/dl

Serum chemistry

Sodium 140 mEq/L

Potassium 3.8 mEq/L

Chloride 100mEq/L

Bicarbonate 24 mEq/L

Blood urea nitrogen 14mg/dl

Creatinine 08mg/dl

Calciu m 92mg!dl

Glucose 102 mgldl

Thyroid functlOfl tests are nomial In addition to high-intensity statin therapy, which of the followmg 1s the best recom mendation for

managemeot of thrs patient’s lipid disorder?

  • Q A Carbohydrate-free diet
  • Q B Extended-release n1acm
  • O C Gemflbroz11
  • Q D Metformin
  • Q E Reduced alcohol intake
  • Q F Vitamin E supplementation

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45-year-old male presents for a routine checkup because he wishes to purchase life insurance. He says he feels “perfectly healthy”

and has no complaints. Hi.s medical history is significant for a remote bout of cellulitis and a fractured clavicle from playing football in

high school. He works as a supervisor at a corporate call center. He is monogamous and lives with his wife and two children.

Laboratory testing reveals the foll owing:

Total bilirubin 0.9 mg/dL

Direct bilirubin 0.2 mg/dL

Aspartate aminotransferase (SGOT) 244 U/L

Alanine aminotransferase (SGPT) 155 U/L

Hemoglobin 13.8g/L

Erythrocyte count 4.6mln/mm3

MCV 95 fl

Platelets 290,000/mmJ

Leukocyte count 5,500/mm3

Serum sodium 142 mEq/l

Serum potassium 3.9 mEq/l

Chloride 105 mEq/L

Bicarbonate 26 mEq/l

Blood urea nitrogen (BUN) 21 mg/dl

Serum creatinine 0.9 mg/dl

Calcium 8.3 mg/dl

Blood glucose 92 mg/dl

What is the next best step in the evaluation of this patient?

  • Q A Order viral serology testing
  • Q B . Obtain more history about alcohol or drug intake
  • Q C. Obtain abdominal ultrasound
  • Q 0 . Order urine copper, serum capper, and ceruloplasmin levels
  • Q E. Order serum iron and ferritin levels

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