A 73-Year-Old Woman Comes to the Emergency Department Due to Vision

question 53

Multiple Choice

A 73-year-old woman comes to the emergency department due to vision changes.  Over the last few days, she has noticed blurred vision and scattered blind spots while watching television.  She reports poor appetite and fatigue since an episode of gastroenteritis 2 weeks ago.  She has no fever, headache, or muscle weakness but admits feeling unsteady.
Her past medical history is significant for hypertension, type 2 diabetes mellitus, heart failure with reduced ejection fraction (ejection fraction of 15%) , and mild chronic obstructive lung disease.  Her medications include tiotropium, torsemide, ramipril, carvedilol, spironolactone, digoxin, and empagliflozin.  The patient is adherent with her medications and clinic visits.  She is a former smoker with a 35-pack-year history.
Her blood pressure is 144/90 mm Hg supine and 140/90 mm Hg standing.  Pulse is 52/min in both positions.  BMI is 19 kg/m².  The mucous membranes appear dry.  Lungs are clear to auscultation and no murmurs are heard on cardiac examination.  There is mild epigastric tenderness on deep palpation.  There is no peripheral edema.  Neurologic examination is unremarkable except for mild unsteady gait.
Fingerstick glucose is 109 mg/dL.
Which of the following is the most likely diagnosis?

• A)Acute angle-closure glaucoma
• B)Cardiac cachexia
• C)Cerebellar stroke
• D)Diabetic retinopathy
• E)Medication toxicity

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Definitions:

Abnormal Behaviour

Actions, thoughts, or emotions that deviate significantly from cultural or societal norms and may impair an individual’s functioning.

Medical Model

A framework for understanding diseases and disorders by focusing on biological factors and excluding psychological or social factors.

Psychopathology

The study of abnormal thoughts, behaviors, and feelings, aiming to understand, diagnose, and treat mental disorders.

Asylums

Historically, institutions designed to house and care for people who are mentally ill or deemed socially undesirable; their usage and conditions have evolved over time.