A 62-Year-Old Business Executive Comes to the Office Due to Episodes

question 796

Multiple Choice

A 62-year-old business executive comes to the office due to episodes of lightheadedness over the last 6 months.  These happen primarily in the morning when he is getting dressed.  During these episodes, the patient feels that the room "is getting dark" and that he is going to pass out.  One time, he briefly lost consciousness.  He has no nausea, chest pain, palpitations, headaches, vision problems, shortness of breath, tongue bites, or urinary incontinence.  His medications include valsartan for high blood pressure.  The patient is a former smoker with a 25-pack-year history.
His blood pressure is 134/85 mm Hg while supine and 140/82 mm Hg after standing for 2 minutes, and pulse is 72/min.  There are no heart murmurs or carotid bruits.  Lungs are clear on auscultation.  Peripheral pulses are full and symmetric in all 4 extremities.  ECG shows normal sinus rhythm.
Which of the following is the best next step in the evaluation of this patient?

• A)Carotid sinus massage
• B)Discontinuation of valsartan and clinical follow-up
• C)Dix-Hallpike maneuver
• D)Electroencephalogram
• E)Treadmill exercise test

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Definitions:

Split Personality

An inaccurate colloquial term that refers to Dissociative Identity Disorder (DID), a psychological condition characterized by the presence of two or more distinct identity or personality states.

Binge-Eating

The act of consuming large quantities of food in a short period of time, typically as part of an eating disorder or as a coping mechanism.

Cognitive Factors

The mental processes involved in gaining knowledge and comprehension, including thinking, knowing, remembering, judging, and problem-solving.

Lack of Ability

Describes a deficiency in the skills or competencies needed to perform tasks or solve problems effectively.