A 36-Year-Old Woman Comes to the Emergency Department Due to Severe

question 401

Multiple Choice

A 36-year-old woman comes to the emergency department due to severe headache and vision disturbance.  The symptoms began abruptly an hour ago, and since then she has also felt weak, dizzy, and nauseated.  The patient has had no similar symptoms in the past.  Medical history is significant for a prolactinoma diagnosed a month ago, which is being treated with cabergoline.  She does not use tobacco, alcohol, or illicit drugs.  Temperature is 37.6 C (99.7 F) , supine blood pressure is 80/50 mm Hg with a decrease to 60/40 mm Hg on standing, and pulse is 110/min.  On physical examination, the patient appears anxious and in moderate distress.  There is mild ptosis and impaired adduction on the right.  Bitemporal hemianopsia is present.  Bilateral upper and lower extremity muscle strength and sensation are normal.  The neck veins are flat, heart and lung sounds are normal, and there is no abdominal tenderness or extremity edema.  Which of the following is the most likely underlying cause of this patient's hemodynamic changes?

• A)Decreased adrenal hormone levels
• B)Dopaminergic medication adverse effect
• C)Increased global intracranial pressure
• D)Loss of central sympathetic output
• E)Subarachnoid blood-induced vasospasm

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Definitions:

Retained Earnings

The portion of net income that is not distributed to shareholders as dividends, but rather kept by the company for reinvestment in its operations or to pay debt.

Closing Process

The accounting procedures used to close out business accounts at the end of an accounting period.

Income Summary Account

A temporary ledger account used during the closing process that accumulates revenues and expenses before transferring the net amount to the capital or retained earnings account.

Net Income

The sum of money a company retains as profit after all financial obligations and taxes are deducted from its total income.