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1.A 66-year-old retired carpenter presents with

chronic shortness of breath upon exertion. He

has smoked a pack of cigarettes per day for the

past 5 years and drinks alcohol regularly. On

physical examination, a displaced point of

maximal impulse and hepatosplenomegaly are

noted. His medications include pantoprazole

for gastroesophageal reflux and sertraline for

depression. Echocardiogram reveals an ejection

fraction of 30% and dilated left and right

ventricles. Laboratory test results are:

Na−129 mEq/L

K5.2 mEq/L

Cl−101 mEq/L

Blood urea nitrogen 45 mg/dL

Creatinine 1.3 mg/dL

Glucose 134 mg/dL

Aspartate aminotransferase 220 U/L

Alanine aminotransferase 140 U/L

Alkaline phosphatase 280 U/L

Which of the following is the most likely etiology

of his cardiac findings?

(A) Borrelia burgdorferi

(B) Cigarette smoking

(C) Coxsackie B virus

(D) Ethanol

(E) Pantoprazole toxicity

(F) Trypanosoma cruzi


(D) Ethanol

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