Reference no: EM133625739

Question 

Mr. Evans is a 75 year old man was diagnosed with unstable angina 11 months ago. He had an uncomplicated recovery following stent placement in his left anterior descending coronary artery. He recently began taking over-the-counter ibuprofen after "throwing his back out" while cleaning out his garage. He comes to your office at his wife's urging after noticing black, foul-smelling, tarry stools and an episode of lightheadedness. He has regular bowel movements, on average once a day and has one or two stools measuring "about one or maybe half a cup each." Defecation is not painful. He has no abdominal pain, no symptoms of dyspepsia, or heartburn. He denies episodes of hematemesis. Stat H/H in the office is 12.8 g / 38.4% Medical History Hypertension x 20 years Hyperlipidemia x 18 years Normal screening colonoscopy 7 years prior NKDA Tobacco: 30 pack-years (quit 1 year ago) Alcohol: 1-2 alcoholic drinks/day for the past several years Drugs: none Medications HCTZ 25 mg/day Lisinopril 20 mg/day Carvedilol 50 mg/day Atorvastatin 20 mg/day Aspirin 81 mg/day Clopidogrel 75 mg/day OTC ibuprofen Family History Father - deceased age 73, MI Mother - deceased age 57, breast cancer Sister - alive, diagnosed with breast cancer.