An elderly, male patient has come in for an annual physical. He is walking slowly with a cane and is worried about an unusual looking spot on his chest. As you prepare him for his physical, what are some of the challenges that you may encounter? Also, how would you communicate with him about the spot on his chest he is worried about? What are some of the tests the doctor may order as part of a routine physical? If a referral is necessary for the lesion on the patient's chest, what type of doctor would he be referred to?

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Analyze the relationship between good nutrition and disease prevention: how can reducing your saturated fat intake lower the risk of heart disease?

A46-year-old man with a history of hypertension and hypercholesterolemia visits the physician for a routine followup. the patient's job involves a lot of travelling, and he admits to occasionally forgetting to take his medications with him when he travels. he complains of several episodes of chest pain in the past few months. the pain is sharp in nature, mainly over his lower chest and epigastrium, and tends to come on when walking. he believes these episodes are due to indigestion and has been taking antacids. there is a family history of heart disease, and his father died of a heart attack at age 48. on physical examination, his blood pressure is 150/80 mmhg and heart rate is 86/min. his lungs are clear to auscultation. cardiac auscultation reveals normal rate and rhythm, without rubs, gallops, or murmurs. there is no pedal oedema. he is sent for an exercise stress test. five minutes into the test, he develops st depression of 3mm in leads v1-v5. the st segment depression is greater than 0.12 seconds in duration and the stress test is stopped. which of the following is the most appropriate next step in management? - coronary angiography- holter monitor- no further tests are required- repeat stress test with thallium- upper gastrointestinal endoscopy