65-year-old man with nonischemic cardiomyopathy treated with furosemide


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65-year-old man with nonischemic cardiomyopathy treated with furosemide, carvedilol, lisinopril, and digoxin comes to the

emergency department with palpitations. His last left ventricular ejection fraction was 35%. His blood pressure is 160/100 mm Hg

and pulse is 130/min and irregular Lungs are clear to auscultation. The abdomen is soft and nondistended. Mild epigastric

tenderness is elicited on deep palpation. Electrocardiogram shows atrial fibrillation with rapid ventricular response and nonspecific Twave

changes. Therapy with rivaroxaban and amiodarone is initiated with improvement in symptoms. The patient is discharged

home after 2 days. Two weeks later, he returns to the emergency department with profound anorexia, nausea, and generalized

weakness. Which of the following is the most likely cause of this patient’s symptoms?

  • QA Drug interaction
  • 0 B. Erosive gastritis
  • 0 C. Gastrointestinal bleeding
  • 0 D. Mesenteric ischemia
  • 0 E. Occult carcinoma
  • 0 F. Pane reatitis

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3-year-old boy is brought to the emergency department due to loss of consciousness while playing at a park The boy was short of

breath from running when he appeared blue and went limp for approximately 10 seconds. His mother caught his fall and says that he

regained consciousness quickly. He did not hit his head or experience any trauma. However, the patient has previously lost

consciousness during excess crying and temper tantrums. The events are brief and accompanied by blue discoloration of his lips

The patient was born full term via normal vaginal delivery, and there was no known history of cyanosis or jaundice in the neonatal

period He has met all developmental milestones. The patient’s father has hypertension and hyperlipidemia, and his paternal uncle

has a seizure disorder. Temperature is 37.5 C (99.5 F), pulse is 110/min, and respirations are 45/min. Physical examination shows an

alert and mildly cyanotic boy with a systolic ejection murmur along the mid to upper left sternal border. When the child squats, the

murmur becomes louder and the cyanosis improves The abdomen is soft, nontender, and nondistended. No organomegaly is

present Femoral and brachia! pulses are equal and 2+. Deep tendon reflexes are 2+. Which of the following is the most likely

diagnosis in this patient?

  • QA Absence epilepsy
  • 0 B. Breath-holding spell
  • 0 C. Generalized seizure
  • 0 D. Hypertrophic cardiomyopathy
  • 0 E. Isolated atrial septal defect
  • 0 F Tetralogy of Fallo!
  • 0 G. Vasovagal syncope

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