A 42-year-old man with a history of Marfan syndrome presents to the emergency room with severe, sudden, tearing chest pain radiating to the abdomen and back. The pain has progressively shifted downward over the past several hours. He admits to recent cocaine use and has a history of hypertension, previously treated with hydrochlorothiazide, which he discontinued due to thunderclap headaches. He smokes one pack of cigarettes daily. Vital signs: Temperature: 99.8 °F Heart rate: 108 beats/min (right arm); 94 beats/min (left arm) Blood pressure: 198/105 mm Hg (right arm); 170/94 mm Hg (left arm) Respiratory rate: 19 breaths/min Oxygen saturation: 94% on room air On physical examination, the patient has asymmetric pulses and signs of intravenous drug use (track marks, scarring). An electrocardiogram reveals wide QRS complexes, and a chest X-ray shows a widened mediastinum (as shown below). Laboratory findings include normal troponin and D-dimer levels.Which of the following is the most likely diagnosis in this patient?
A 62-year-old man with obesity, hypertension, diabetes, smoking, and dyslipidemia stopped taking atorvastatin a few months ago due to muscle discomfort, night cramps, and tendon soreness. His symptoms resolved after discontinuing atorvastatin. After discussing statin-associated musculoskeletal syndrome (SAMS), he expresses a desire to restart atorvastatin at a tolerated dose. He has also made dietary changes to reduce lipid intake. What is the next step in managing his hypercholesterolemia?
Which of the following is a component of long-term risk reduction in patients with unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI)?
What is the first-line pharmacologic treatment for elevated LDL cholesterol in most individuals who are not pregnant or breastfeeding?
A 65-year-old man presents to your primary care office with pain in his right lower leg and is concerned about a possible blood clot. On examination, there is tenderness with palpation over the left calf muscles. His medical history includes hypertension, hyperlipidemia, and depression. Current medications are lisinopril, clonidine, rosuvastatin, sertraline, and aspirin. Before proceeding with investigations for a possible clot, you consider whether any of his medications might be contributing to his leg pain. Which medication is most likely responsible for his symptoms?
A 64-year-old female comes to your office to establish care. When asked about her current medications, she reports taking lisinopril and metformin but mentions discontinuing a cholesterol medication because it caused an upset stomach and a fishy odor to her breath. Which of the following medications is she most likely referring to based on these adverse effects?
A 70-year-old male comes to your primary care center for the management of his hypertriglyceridemia. His medical history is significant for hypertension, diabetes and coronary artery disease. His current medications include aspirin, lisinopril, insulin and rosuvastatin. His current triglyceride level is 498 mg/dL. Of the following, which medication can lower his triglycerides and decrease the risk of future cardiac events?
A 56 year-old male comes to your office for the management of his very high LDL levels. He has been taking a statin for a few years but his LDL levels have not come down to a desired level. You decided to add a fibrate to his treatment regimen. Of the following, which is the most concerning adverse effect to be monitored when you add a fibrate to a statin?
