Review Question - QID 212369

A 49-year-old man presents to his primary care physician complaining of multiple symptoms. He states that over the past 8 months he has noticed voice changes and difficulty swallowing. The dysphagia started with just dry foods like crackers but has progressed to include smoothies and ice cream. He works as a newspaper editor and has also noticed trouble writing with his dominant hand. He is accompanied by his wife, who complains that he snores and drools in his sleep. His medical history is significant for hypertension and a bicuspid aortic valve. He takes hydrochlorothiazide. His temperature is 98.7°F (37°C), blood pressure is 138/91 mmHg, pulse is 78/min, respirations are 12/min, and oxygen saturation is 98% on room air. On physical examination, there is atrophy of the right hand. The patient’s speech is slow. A systolic murmur at the right upper sternal border is appreciated. Tapping of the left patellar tendon causes the patient’s left lower extremity to forcefully kick out. Stroking of the plantar aspect of the patient’s left foot causes his left toes to extend upward. Which of the following therapies is most likely to slow the progression of the patient’s symptoms?