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A 32-Year-Old Woman, Gravida 1 Para 0, at 32 Weeks

question 172

Multiple Choice

A 32-year-old woman, gravida 1 para 0, at 32 weeks gestation is brought to the emergency department due to anterior chest and neck pain that began 3 hours ago. The pain was severe at onset but has decreased to moderate discomfort. She also has had mild nausea and epigastric discomfort. After the onset of the chest pain, the patient experienced tingling and weakness of her right arm accompanied by blurry vision and headache that lasted approximately 20-30 minutes. She has had a healthy pregnancy except for development of gestational diabetes mellitus at 24 weeks gestation. The patient's blood pressure was elevated during her last prenatal visit, and she was started on an antihypertensive medication. She has no other significant medical history. She does not use tobacco, alcohol, or illicit drugs.
On physical examination, the patient appears comfortable. Blood pressure is 176/104 mm Hg in the right arm and 180/99 mm Hg in the left arm, and pulse is 96/min. Oxygen saturation is 94% on room air. Her right pupil measures 4 mm and her left pupil measures 2 mm. There is slight ptosis on the left side. Lung fields are clear to auscultation with equal air entry on both sides. Cardiac examination reveals regular heart sounds with normal S1 and S2. The neurologic examination is otherwise unremarkable. Peripheral pulses are equal in all extremities. There is 2+ pitting peripheral edema of both lower extremities with some engorged varicose veins. There are normal deep tendon reflexes without clonus.
ECG shows sinus rhythm and a 1-mm downsloping ST-segment depression in leads aVL, V5, and V6. Urinalysis shows 1+ ketones, no protein, and no glucose.
Which of the following is the best next step in management of this patient?

Definitions:

Feature Analysis

A process in cognitive psychology focusing on how the brain decomposes visual stimuli into individual features or components for recognition.

Bottom-Up

An approach to process information by starting with the specifics and then building up to a complete understanding.

Top-Down

An approach or process that is initiated from the higher levels of a hierarchy and carried through to the lower levels, often in decision-making or processing information.

Perceptual Set

A psychological framework that predisposes individuals to perceive information in a particular way based on their expectations, emotions, and experiences.