input: The following are multiple choice questions (with answers) about medical knowledge.   **Question:** A 63-year-old man comes to the emergency department because of retrosternal chest pain. He describes it as 7 out of 10 in intensity. He has coronary artery disease, hypertension, and type 2 diabetes mellitus. His current medications are aspirin, simvastatin, metformin, and enalapril. He has smoked one pack of cigarettes daily for 33 years. On arrival, his pulse is 136/min and irregular, respirations are 20/min, and blood pressure is 85/55 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. An ECG is shown. Which of the following is the most appropriate next step in management?   (A) Coronary angiogram   (B) Intravenous esmolol   (C) Intravenous amiodarone   (D) Synchronized cardioversion
output: ['(D) Synchronized cardioversion <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Coronary angiogram  (B) Intravenous esmolol  (C) Intravenous amiodarone  (D) Synchronized cardioversion <> possible answers', '  A 63-year-old man comes to the emergency department because of retrosternal chest pain. He describes it as 7 out of 10 in intensity. He has coronary artery disease, hypertension, and type 2 diabetes mellitus. His current medications are aspirin, simvastatin, metformin, and enalapril. He has smoked one pack of cigarettes daily for 33 years. On arrival, his pulse is 136/min and irregular, respirations are 20/min, and blood pressure is 85/55 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. An ECG is shown. Which of the following is the most appropriate next step in management? <> context']