A CT scan of the head with and without contrast reveals no abnormalities

Medicoman · January 24, 2020, 11:08am

65-year-old man is found confused and lethargic on the floor of his apartment His medical history includes hypertension, diabetes

mellitus, coronary artery disease, tra nsient ischemic attacks, chronic renal disease, and osteoarthritis. The patient’s temperature is

37.3 C (99.2 F) and blood pressure is 137/67 mm Hg He has palpable pulses bilaterally Right-sided weakness and facial droop are

noted on initial assessment. Laboratory results are as follows:

Sodium 133 mEq/L

Potassium 7.4 mEq/L

Chloride 104[mEq/L

Bicarbonate 18 mEq/L

Blood urea nitrogen 36 mg/dl

Creatinine 2.9 mg/dl

Calcium 8.4 mg/dl

Glucose 208 mg/dl

Which of the following is the most appropriate next step in management of this patient?

0 voters

35-year-old man is brought to the emergency department by his roommate, who says that he has been acting

“weird” for the past 2 days. The patient has spent most of the time in his room and has not been eating much. He

has no headaches, focal weakness, or sensory symptoms. His medical history is significant for untreated HIV and

hepatitis C infections. Temperature is 37.9 C (100.2 F), blood pressure is 140/86 mm Hg, pulse is 96/min, and

respirations are 16/min. Mild scleral icterus is present. The oropharynx is normal and there is no nuchal rigidity.

Examination of the chest and abdomen are unremarkable. Neurologic examination reveals no focal deficits.

Laboratory results are as follows:

Hemoglobin 7.6 g/dL

Mean corpuscular 85 μm3

volume

Reticulocytes 8.1 %

Platelets 45,000/mm3

Leukocytes 4500/mm3

Serum chemistry

Blood urea nitrogen 30 mg/dL

Creatinine 2.2 mg/dl

Calcium 9.4 mg/dl

Glucose 98 mg/dl

Total bilirubin 3.2 mg/dl

Indirect bilirubin 2.2 mg/dl

Alkaline phosphatase 108 U/L

Aspartate aminotransferase 62 U/L

Alanine aminotransferase 64 U/L

A CT scan of the head with and without contrast reveals no abnormalities. Which of the following is the most

appropriate next step in the management of this patient?

0 voters