A 73-Year-Old Man Is Brought to the Emergency Department by His

question 140

Multiple Choice

A 73-year-old man is brought to the emergency department by his daughter for mild confusion, double vision, and frequent falls over the past 2-3 weeks.  He has also been having headaches, decreased appetite, and nausea.  His past medical history is significant for diet-controlled type 2 diabetes mellitus and hypertension.  The patient underwent resection of a malignant melanoma 2 months ago.
His blood pressure is 142/88 mm Hg and heart rate is 67/min.  He appears comfortable and answers questions appropriately.  There is no nuchal rigidity.  Neurologic examination shows diplopia, mild weakness and spasticity of the right arm, and ataxic gait.
Which of the following is the next best step in management of this patient?

• A)Acyclovir therapy
• B)CT scan of the head with contrast
• C)Lumbar puncture
• D)MRI of the brain and spine
• E)Vitamin B₁₂ level

---

Definitions:

Economies of Scale

The cost advantages that enterprises obtain due to their scale of operation, leading to a reduction in average costs with increased output.

Total Fixed Cost

Total Fixed Cost is the sum of all costs that remain constant regardless of the level of production or business activity.

Economies of Scale

Businesses gain cost benefits from increasing their scale of operations, leading to a decline in the cost per unit of output as the production size enlarges.