A 70-Year-Old Caucasian Male Presents to Clinic Complaining of "Some

question 373

Multiple Choice

A 70-year-old Caucasian male presents to clinic complaining of "some very disturbing whirling attacks."  He says that on three occasions in this past week, he suddenly began to feel dizzy, nauseated, and found himself unable to walk or speak properly.  During these episodes he also noticed a tingling sensation in his lips and that he had double vision.  The symptoms resolved gradually after lasting approximately eight to ten minutes.  The episodes happened at different times of day, both while at rest and during activity.  His medical history is significant for diabetes mellitus, chronic obstructive pulmonary disease, hypertension, hypercholesterolemia, and a remote myocardial infarction.  His current medications include metformin, enalapril, hydrochlorothiazide, simvastatin, albuterol, and aspirin.  He has a fifty-pack-year smoking history and drinks 1-2 beers per night.  He denies having ever used recreational drugs.  His temperature is 36.7C (98F) , blood pressure is 142/88 mm Hg, pulse is 82/min, and respirations are 14/min.  Funduscopic examination shows some neovascularization of the retinal surfaces.  Tympanic membranes are translucent and the light reflex is present.  Heart sounds are normal.  Auscultation of the chest reveals wheezing and diffusely decreased breath sounds.  He is barrel-chested.  Abdomen is nontender and bowel sounds are present.  Mild peripheral edema is evident.  There is a loss of vibratory sensation and altered proprioception and impairment of pain, light touch, and temperature in a bilateral stocking-glove distribution.  Ankle reflexes are decreased.  His most recent laboratory evaluation included the following: What is the most likely diagnosis?

• A)Labyrinthitis
• B)Benign paroxysmal positional vertigo
• C)Vertebrobasilar insufficiency
• D)Panic attacks
• E)Cataplexy

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Definitions:

Rotor Runout

The measurement of how much a brake rotor deviates from a perfectly flat orientation as it rotates.

Wheel Bearings

Mechanical assemblies that enable the wheels of a vehicle to rotate smoothly and with reduced friction on their axles.

Supply Reservoir

A storage tank or container that holds a supply of fluid, such as fuel, hydraulic fluid, or air, for use in various systems of a vehicle or machinery.

Primary Circuit

In brake systems, refers to the lead circuit in the system; in hydraulic brake systems on straight trucks this is usually the front brake circuit, whereas on large trucks with air brakes, it refers to the brakes over the tandem drive wheels.