A 65-Year-Old Woman Comes to the Emergency Department for Transient

question 1000

Multiple Choice

A 65-year-old woman comes to the emergency department for transient weakness.  She experienced muscle weakness in her right arm and leg this morning that lasted approximately 20 minutes and has since resolved completely.  The patient has had no headache, vision loss, or vomiting.  She has never before had similar symptoms.  Medical history is significant for hypertension and diet-controlled type 2 diabetes mellitus.  The patient underwent mitral valve replacement with a bioprosthetic valve 5 years ago due to mitral valve endocarditis.  She is a life-long nonsmoker.  Blood pressure is 131/70 mm Hg, and pulse is 65/min and regular.  Chest examination is unremarkable.  Neurologic examination reveals no muscle weakness or sensory loss.  ECG, complete blood count, and renal function are within normal limits.  In addition to a neuroimaging study, which of the following is the best next step in management of this patient?

• A)Echocardiography
• B)Electroencephalography
• C)Hypercoagulability studies
• D)Peripheral blood smear
• E)Serum antinuclear antibodies

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Definitions:

Use of Cash

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Money owed to a company by its clients or customers for goods or services delivered but not yet paid for.

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Liabilities of a business that represent its obligations to pay off short-term debts to its creditors or suppliers.

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A form of investment indicating a share in a company's ownership, entitling the holder to a portion of its profits or losses.