A 45-Year-Old Man Is Brought to the Emergency Department Due

question 1104

Multiple Choice

A 45-year-old man is brought to the emergency department due to a progressively worsening headache and difficulty breathing.  Yesterday morning, he arrived in Colorado from Kansas for a ski vacation.  The patient was feeling well until last night, when he began experiencing a headache and shortness of breath with exertion.  The headache came on gradually, is generalized, and affects his ability to sleep.  This morning, he developed vomiting and dizziness.  The patient has had no fever, neck pain, or chest pain.  He has no significant medical history and exercises daily.  Temperature is 37.2 C (99 F) , blood pressure is 130/80 mm Hg, pulse is 99/min, and respirations are 22/min.  Pulse oximetry is 96% on room air.  The patient is mildly drowsy but can converse.  He is oriented to time, place, and person.  Cardiopulmonary examination is normal.  There are no focal neurologic findings.  The skin is normal.  Which of the following is the most appropriate next step in management?

• A)Dexamethasone
• B)Doxycycline
• C)Furosemide
• D)Intubation and mechanical ventilation
• E)Low-molecular-weight heparin

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