An 80-Year-Old Woman Presents to the Clinic with Increasing Fatigue

question 290

Multiple Choice

An 80-year-old woman presents to the clinic with increasing fatigue, dizzy spells, and nausea.  She has been followed for several years for osteoporosis, type 2 diabetes mellitus, depression, and mild cognitive impairment.  She was recently started on treatment for systolic hypertension.  She lives independently with support provided by a visiting nurse three times weekly.  She performs all of her own activities of daily living.
Her current medications include alendronate, sertraline, metformin, and hydrochlorothiazide.
Her temperature is 36.7 C (98.1 F) , blood pressure is 146/70 mm Hg supine and 139/75 mm Hg standing (160/75 mmHg during the previous visit) , pulse is 84/min, and respirations are 14/min.  She is 5' 5" (165 cm) and her BMI is 19 kg/m².  There is 2/6 ejection-type systolic murmur at the right upper sternal border without radiation to the carotids.  Her lungs are clear.  Muscle strength is preserved and deep tendon reflexes are symmetrical bilaterally.  Her gait is mildly unsteady.  Her mini-mental status exam score is 22/30 (1 year ago 27/30) .  Fingerstick glucose level is 220 mg/dL.
Which of the following is most likely responsible for this patient's current symptoms?

• A)Cerebellar stroke
• B)Hypercalcemia
• C)Hyperglycemia
• D)Hyponatremia
• E)Volume depletion

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Definitions:

Dendrite

Branching extension of a neuron’s cell membrane; greatly increases the cell’s surface area; collects information from other cells.

Synaptic Vesicles

Small organelles within neurons that store neurotransmitters, which are released into the synaptic cleft during synaptic transmission.

Neurotransmitters

Chemicals located and released in the brain to allow an impulse from one nerve cell to pass to another nerve cell.

Electron Microscope

A type of microscope that uses a beam of electrons to create an image of a specimen, offering higher resolution than traditional light microscopes.