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A 62-Year-Old Man Comes to the Emergency Department Due to Right

question 468

Multiple Choice

A 62-year-old man comes to the emergency department due to right upper extremity weakness. Thirty minutes ago, the patient was at his office when he developed difficulty holding a pen. His grip in the right hand was weak and he could not lift his right arm. He tried calling his coworker but could not speak. The patient has never had similar symptoms before. He had no loss of consciousness, weakness of other extremities, vision abnormality, or headache. The symptoms resolved spontaneously by the time paramedics arrived. Medical history is significant for hypertension and a 30-pack-year smoking history. The patient is a defense attorney and recently took on a high-profile case. Temperature is 36.9 C (98.4 F) , blood pressure is 140/84 mm Hg, pulse is 82/min and regular, and respirations are 14/min. Physical examination shows no extremity weakness or sensory loss. There is a left carotid bruit; the remainder of the examination shows no abnormalities. Noncontrast CT scan of the head is normal. Which of the following pharmacotherapies is most appropriate in management of this patient?

Definitions:

Recirculating Ball

A type of steering mechanism in vehicles that uses a series of ball bearings to minimize friction and wear in the steering box.

Gearbox

In a steering mechanism, the use of gears to increase the mechanical advantage and decrease driver effort in turning the steering wheel while converting the wheel’s motion into motion that moves the vehicle’s front wheels.

U-joint

A universal joint, a flexible pivot point that transmits power allowing for varying angles of the drive shaft.

Steering Assembly

The collection of components in a vehicle that allows the driver to guide and direct the vehicle in the desired direction.