A 35-Year-Old Man Comes to the Emergency Department with Shortness

question 1663

Multiple Choice

A 35-year-old man comes to the emergency department with shortness of breath that started 2 days ago and worsened last night.  He also has a dry cough.  The patient has a history of hypertension, and his medications include chlorthalidone, amlodipine, and labetalol.  He ran out of his medications about 3-4 days ago.  The patient smokes a pack of cigarettes and drinks 4-5 beers on the weekends.  His last drink was 4 days ago.  The patient's temperature is 36.7 C (98 F) , blood pressure is 220/120 mm Hg, pulse is 105/min, and respirations are 20/min.  Oxygen saturation is 96% on 2 liters of oxygen via nasal cannula.  Chest auscultation shows bibasilar crackles and fourth heart sound.  Funduscopic examination shows normal optic discs and occasional cotton-wool spots.  His serum potassium is 5.0 mEq/L, and creatinine is 2.1 mg/dL.  The patient is admitted to the coronary care unit and started on intravenous furosemide and nitroprusside infusion with improvement of his symptoms.  The next morning, the nurse finds him confused and agitated, and he has a generalized tonic-clonic seizure.  His temperature is 36.7 C (98 F) , blood pressure is 176/95 mm Hg, and pulse is 102/min.  Physical examination shows normal breath sounds bilaterally and no focal muscle weakness.  Which of the following is the most likely cause of this patient's new neurologic findings?

• A)Alcohol withdrawal
• B)Aortic dissection
• C)Cyanide toxicity
• D)Excessive hypotensive response
• E)Hypertensive encephalopathy
• F)Ischemic stroke
• G)Severe hyperkalemia

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Definitions:

Gestalt Principle

The Gestalt principle suggests that humans naturally perceive objects as organized patterns and unified wholes rather than as separate components.

Gestalt Principle

A theory in psychology proposing that people naturally organize their perceptions according to certain patterns or wholes, rather than focusing on individual components.

Proximity

The physical or psychological closeness or nearness of objects, individuals, or concepts to one another.

Gestalt Psychology

A theory of mind stating that psychological phenomena should be viewed as organized, structured wholes rather than the sum of their parts.