56-year-old man comes to the physician complaining of 2 weeks of intermittent dizziness. He gets a brief spinning sensation when
turning over in bed or looking up at objects on a high shelf. He has no nausea, diaphoresis, chest pain, or tinnitus. The patient’s past
medical history is significant for long-standing hypertension and hypercholesterolemia. Current medications include
hydrochlorothiazide and simvastatin. His father died of a stroke at age 62. His blood pressure is 130/80 mm Hg (supine) and 135/85
mm Hg (standing) and his pulse is 77/min. A grade IINI ejection murmur is heard at the left sternal border. Precordial palpation and
carotid upstroke are normal. Cranial nerve examination is within normal limits. Electrocardiogram shows normal findings Which of
the following is the most likely cause of this patient’s complaints?
- QA Aortic stenosis
- 0 B. Cardiac arrhythmia t
- 0 C. Extracellular sodium loss
- 0 D. Semicircular canal dysfunction
- 0 E. Transient ischemic attacks
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