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A 68-Year-Old Right-Handed Man Is Brought by Ambulance to the Emergency

question 179

Multiple Choice

A 68-year-old right-handed man is brought by ambulance to the emergency department after his wife found him unresponsive. The wife states that her husband had not been feeling well for the last 12 hours. He woke up this morning "complaining of dizziness, neck pain, unsteadiness, and headache." As the day progressed, his symptoms worsened and he started vomiting. Towards the evening, the patient was lethargic and more confused than at his baseline. He has not had any fevers or chills.
His medical problems include poorly controlled hypertension, hyperlipidemia, ischemic stroke due to untreated high-grade left carotid artery stenosis, COPD on home oxygen, and chronic low back pain treated with oxycontin and hydrocodone. He lives with his wife and depends on her for most of his activities of daily living. For the past several months, his wife has had more difficulty taking care of him and administering his medications properly. She states that the patient has been "abusing his narcotic medications."
His temperature is 37.1 C (98.8 F) , blood pressure is 170/110 mm Hg, pulse is 40/min, and oxygen saturation is 85% on room air. His general physical examination reveals a left carotid bruit, S4 gallop, and prominent expiratory wheezes with reduced air flow. On neurological examination, he appears comatose. Cranial nerve testing reveals absence of blink-to-threat, mid-position fixed and dilated pupils, absence of oculocephalic reflex, and presence of corneal, gag, and cough reflexes. Motor examination reveals extensor posturing in the upper and lower extremities. Reflexes are absent and plantar responses are mute. He does not grimace to pain.
Which of the following is the most likely etiology for this patient's presentation?

Definitions:

Capital Structure

Capital structure refers to the way a corporation finances its assets through some combination of equity, debt, or hybrid securities.

Flotation Costs

Expenses incurred by a company in issuing new securities, including fees to underwriters, legal fees, and registration fees.

Dividend

A portion of a company's earnings distributed to shareholders, usually in the form of cash or additional stock.

Constant Growth

A model assuming that dividends or any other type of cash flow grow at a constant rate indefinitely.