Three real questions.
Parsing, exposed.

A 72-year-old man with a history of chronic kidney diseaseCondition presents to his primary care physician complaining of recurrent chest painSymptom with activity. The patient used to have chest painSymptom when he mowed his lawn. Now he gets chest painSymptom whenever he walks short distances such as to get his mail. The pain resolves on its own when the patient sits and rests. His temperature is 98.2°F (36.8°C), blood pressure is 157/98 mm Hg, pulse is 80/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for an obese man who is in no distress. An initial ECGDiagnostic Test is unchanged from a previous ECGDiagnostic Test. The patient's first troponin is 0.06 ng/mL which is unchanged from previous troponins. Which of the following is the most likely diagnosis?

1. A

   NSTEMICondition

2. B

   Stable anginaConditionClinical Finding

3. C

   Unstable anginaConditionClinical Finding

4. D

   Variant anginaConditionClinical Finding

A 56-year-old man comes to the emergency department because of a 1-day history of progressive swelling and pain in his left calf. He does not have shortness of breathClinical Finding or chest painSymptom. He has hypertensionCondition and chronic kidney diseaseCondition. Current medications include enalaprilMedication, aspirinMedication, simvastatinMedication, and vitamin D. His temperature is 38°C (100.4°F), pulse is 84/min, and blood pressure is 135/92 mm Hg. Physical examination shows tendernessPhysical Exam and swelling of the left lower extremity. A venous Doppler ultrasonographyImaging Study shows a thrombus in the left popliteal vein. Treatment with unfractionated heparinMedication is begun. Two days later, physical examination shows improvement of symptoms. Laboratory studies at admission and 2 days after admission show: Admission / two days after admission — Hemoglobin 11.2 g/dLLaboratory Test / 11.1 g/dL; Leukocyte count 5500Laboratory Test/mm³ / 6100/mm³; Platelet count 230,000Laboratory Test/mm³ / 170,000/mm³; Prothrombin time 12Laboratory Test seconds / 13 seconds; Partial thromboplastin time 30Laboratory Test seconds / 55 seconds; Estimated glomerular filtration rate 29 mL/minLaboratory Test/1.73 m² / 28 mL/min/1.73 m². Which of the following is the most appropriate next step in management?

1. A

   Switch to enoxaparinMedication

2. B

   Continue unfractionated heparinMedication

3. C

   Switch to warfarinMedication

4. D

   Discontinue anticoagulation

5. E

   Switch to argatrobanMedication

A 33-year-old woman is brought to the emergency department 15 minutes after being stabbed in the chest with a screwdriver. Her pulse is 110/min, respirations are 22/min, and blood pressure is 90/65 mm Hg. Examination shows a 5-cm deep stab wound at the upper border of the 8th rib in the left midaxillary line. Which of the following structures is most likely to be injured in this patient?

1. A

   Intercostal nerve

2. B

   Left liver lobe

3. C

   Spleen

4. D

   Lower lung lobe

5. E

   Left ventricle

6. F

   Left kidney