Solved

An 82-Year-Old Man Is Evaluated for Dizziness

question 190

Multiple Choice

An 82-year-old man is evaluated for dizziness. He has felt dizzy for the past year, and the sensation is worsening. The dizziness occurs primarily when he ambulates; however, it does not bother him while seated or recumbent, and is not accentuated by head turning. He denies a sensation of spinning or movement, headache, focal weakness, palpitations, or muscle pain. He fell twice over the last year, but he did not sustain any significant injuries. His hearing has been poor for several years. He has visual difficulties which makes reading difficult.
He has a history of diet-controlled diabetes mellitus, degenerative joint disease of his knees and hips, hypertension, chronic obstructive pulmonary disease, mild cognitive impairment, hyperlipidemia, and post-herpetic neuralgia. His medications include chlorthalidone, ibuprofen, acetaminophen, lovastatin, and a tiotropium inhaler.
His blood pressure is 136/70 mm Hg supine and 130/72 mm Hg standing, and pulse is 84 /min. There is a 2/6 holosystolic murmur at the apex. Breath sounds are generally decreased. Hearing is grossly decreased in both ears. Vision corrects to 20/70 in both eyes. His cranial nerves are intact. There is no nystagmus. Deep tendon reflexes are symmetric. There is decreased vibration, position, and light touch sensation below the knees bilaterally. He cannot walk heel-to-toe, and the Romberg test is positive. He has a slightly broad-based gait with decreased accessory movement. Rapid alternating movements are decreased symmetrically. His score on a Mini-Mental State Examination is 25/30, decreased from 26/30 one year ago. He answers two depression screening tests normally.
Lab tests, including a complete blood count, comprehensive metabolic panel, B12 level, serum RPR, and thyroid function tests are normal. A hemoglobin A1C is 7.5%. An electrocardiogram reveals normal sinus rhythm and left ventricular hypertrophy.
The patient would most likely benefit from which of the following?

Definitions:

Right Angles

Angles that measure exactly 90 degrees.

Indifference Curves

Graphical representations used in microeconomics to show combinations of two goods that provide equal satisfaction and utility to a consumer.

Nickels

Coins in the United States and Canada valued at five cents, made of a cupronickel alloy.

Dimes

A coin representing ten cents in the United States currency.