An 81-Year-Old Woman Is Brought to the Clinic with Complaints

question 45

Multiple Choice

An 81-year-old woman is brought to the clinic with complaints of constant ringing in her ears over the last several months.  She also is having difficulty hearing, especially at social gatherings and while watching television.  She has had 2 episodes of near falls during the past year.  The patient's other medical problems include hypertension, recurrent urinary tract infections, and osteoarthritis.  Her medications include hydrochlorothiazide and acetaminophen.  She takes trimethoprim-sulfamethoxazole for urinary tract infections several times a year.
Physical examination shows a normal external ear, no signs of cerumen impaction, and pearly gray tympanic membranes bilaterally with a normal light reflex.  She is mildly unsteady in Romberg's position with her eyes closed.  There are no carotid bruits.  She has an abnormal whisper test in both ears.
Which of the following is the most likely diagnosis?

• A)Intracranial arterial stenosis
• B)Medication toxicity
• C)Meniere's disease
• D)Otosclerosis
• E)Presbycusis

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Definitions:

Permissive

An adjective describing an approach or policy that allows or tolerates behaviors that might be restricted in more controlled environments.

Adopted Children

Individuals who have been legally taken and raised by parents who are not their biological parents.

Authoritarian

An authoritarian refers to a governing or leadership style characterized by absolute or blind obedience to authority, as against individual freedom and related to centralized power.

Authoritative

A parenting style characterized by high demands and high responsiveness, where parents set clear standards for their children but also encourage independence and are open to communication.