An 81-Year-Old Man Comes to the Physician with an Episode

question 887

Multiple Choice

An 81-year-old man comes to the physician with an episode of right arm weakness and difficulty finding words.  The episode occurred the night before and lasted 90 minutes, followed by slow resolution of symptoms.  He had no loss of consciousness.  He has never had similar symptoms and otherwise feels fine.  The patient's medical history includes hypertension and type 2 diabetes mellitus.  His medications include lisinopril, metformin, and glipizide.  His last hemoglobin A1c was 7.6%.  He quit smoking 5 years ago.
The patient's blood pressure is 130/80 mm Hg and pulse is 88/min.  His body mass index is 30 kg/m².  Cardiac examination shows no murmurs.  No carotid bruits are heard and lungs are clear to auscultation.  Peripheral pulses are full and symmetric.  Neurologic examination, including visual field testing, is within normal limits.  Fingerstick glucose level is 176 mg/dL.  Electrocardiogram shows normal sinus rhythm.
Which of the following is the most appropriate next step in management of this patient?

• A)Admit patient to the hospital
• B)Schedule transthoracic echocardiogram
• C)Start insulin for tighter diabetes control
• D)Start low-dose aspirin and schedule outpatient carotid duplex imaging
• E)Start low-dose aspirin and schedule outpatient MRI of the head

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Definitions:

Indirect Communication

A conversational style where the message is not expressed directly through words but implied through context or non-verbal cues.

Conflict

A situation where competing or opposing needs, interests, or viewpoints lead to disagreement or dispute.

Negatively Affected

Impacted in an adverse manner, leading to detrimental outcomes or decreases in quality, performance, or well-being.

Intrapersonal Conflict

A psychological struggle within oneself that arises from opposing interests, beliefs, or needs.