Alcohol use disorder (5 to 8) 16/02/24
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5) A 45-year-old man presents with symptoms of heart failure, including fatigue, dyspnea on exertion, and peripheral edema. He has a history of chronic alcohol abuse. Echocardiography reveals dilated cardiac chambers with reduced systolic function. Which of the following is the most likely diagnosis?
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6) A 50-year-old man with alcohol use disorder presents with nausea, vomiting, and abdominal pain. He admits to "drinking heavily" for several days, but over the last day, he has been unable to “keep anything down.” His vitals are respiratory rate 28 breaths/min, heart rate 126 bpm, blood pressure 106/62 mm Hg, and temperature 98.6 °F (37 °C). On exam, he has dry mucous membranes, mild diffuse abdominal tenderness, no peritoneal signs, clear lungs, and no lower extremity edema. He has a visible resting tremor that is exacerbated by finger-to-nose maneuvers. His bedside blood glucose is 70 mg/dL. Arterial blood gas analysis results are pH 7.2, pCO2 22 mm Hg, pO2 98 mm Hg, and bicarbonate 15 mEq/L. A basic metabolic panel shows sodium 138 mEq/L, potassium 4 mEq/L, chloride 100 mEq/L, bicarbonate 15 mEq/L, BUN 29mg /dL, and creatinine 1.6 mg/dL. The anion gap is 23. The CT abdomen and pelvis findings are unremarkable. What is this patient’s acid-base status?
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7) A 65-year-old man presents with exertional shortness of breath for the past 2 months. He denies any chest pain. There had been episodes of increased shortness of breath at night, especially after a night of "heavy drinking." His past medical history is significant for alcohol use disorder. His vital signs are blood pressure 110/70 mm Hg, heart rate 85 bpm, and oxygen saturation 94% on room air. His physical examination reveals pallor with multiple spider angiomas on his chest and back. He has increased abdominal girth and lower extremity edema. Cardiac examination reveals an S3 and an S4 gallop. Pulmonary examination reveals bibasilar crackles. His electrocardiogram reveals normal sinus rhythm without any abnormalities. What is the next step in the evaluation? 
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8) A 59-year-old presents with complaints of generalized weakness and dyspnea on exertion. He also reports easy fatigability and difficulty lying flat at night. On examination, he has pulmonary rales, a displaced apical pulse, and bilateral lower extremity edema. An S3 and an S4 gallop are present. There are multiple spider angiomas and jaundice. Laboratory evaluation reveals elevated liver enzyme levels. His chest x-ray reveals an enlarged cardiac silhouette with pulmonary vascular congestion. An echocardiogram shows reduced systolic and diastolic function with dilated cardiac chambers. A stress test is negative for any reversible ischemia. He receives medical therapy for his cardiac condition and undergoes extensive counseling for alcohol cessation. The patient asks about the prognosis of his cardiac disease. What is the appropriate response to his question?
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