A 72-Year-Old Woman Comes to the Emergency Department Due to Acute

question 205

Multiple Choice

A 72-year-old woman comes to the emergency department due to acute dizziness for 6 hours.  The patient awoke this morning with the persistent sensation of "the room spinning around," which becomes worse with head movement.  She also has nausea and vomiting, but no headache or vision problems.  Nothing seems to relieve her symptoms.
Her other medical problems are hypertension and hyperlipidemia.  Home medications include amlodipine and atorvastatin.
Temperature is 36.7 C (98 F) , blood pressure is 160/90 mm Hg, and pulse is 84/min.  On examination, the patient has bidirectional nystagmus.  Muscle strength, light touch and pain sensation, and reflexes are normal throughout.  The patient's gait is unsteady and she tends to fall toward the right side.
Blood sugar is 140 mg/dL and electrolytes are normal.  Noncontrast CT scan of the head is normal.  ECG reveals normal sinus rhythm.
Which of the following is the best next step in management of this patient?

• A)Audiometry
• B)Carotid ultrasound
• C)Ear particle-repositioning maneuvers
• D)MRI of the head
• E)Reassurance and meclizine therapy

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Definitions:

Structural Functionalism

A sociological theory that views society as a complex system whose parts work together to promote solidarity and stability, focusing on social structures and their functions.

Large-scale Social Structures

The overarching frameworks and institutions that shape societies, including economies, political systems, and social norms, influencing individual and group interaction.

Institutions

Established organizations or foundational systems within a society that dictate and regulate patterns of behavior or norms, such as legal or educational systems.

Actors

Individuals or entities that take action or play a role in a particular process, system, or context, contributing to its dynamics.