Elderly dizzy women - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 08-04-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 720
Threads: 217
Thanked 552 Times in 309 Posts
Reputation: 562
Question Elderly dizzy women

An 89-year-old woman developed distressing symptoms over the past 2 days She feels well when lying down, and weak, faint, and "dizzy" when she sits up On standing. she feels unsteady and lightheaded and fears falling and hurting herself She explains that the room is not moving around her, and the floor is steady and secure. Pertinent recent history indicates that approximately 6 weeks ago she took a lot of aspirin because of a cold, after which she had a melanotic stool Two weeks later. laboratory studies showed a hemoglobin of 9 8. and a repeated stool guaiac test was negative for occult GI bleeding Two weeks ago. she was placed on thiazide diuretics because of ankle edema and advised to limit fluid and sodium intake Yesterday. an EKG was done and showed a sinus rhythm at a rate of 59 This is the same pattern that she has had for the past 5 years Her hemoglobin also went up to 10.2 and she wore a Holter monitor for the past 24 hours that showed no rhythm or rate changes when she signaled the presence of symptoms. What would be the next best step in the management of her acute symptoms,

A. Stop the diuretic and temporarily increase and sodium intake
B. Transfuse her up to a haemoglobin of 14
C.-Initiate workup for vestibular disease
D.-Do upper and lower GI endoscopy
E.-Surgically implant a pacemaker.
Reply With Quote Quick reply to this message



  #2  
Old 08-04-2012
USMLE Forums Addict
 
Steps History: 1+CK+CS+3
Posts: 151
Threads: 48
Thanked 111 Times in 60 Posts
Reputation: 121
Default

Hb of 10.2 not bad to warrant transfusion..so B is out..

Room not spinning ....rules out vestibular disease...C is out

Guaiac is negative...if bleeding significant to cause orthostatic hypotension it would be found on Guaiac...rules out D

Holter monitor ..doesnt show any changes during symptoms..rules out E


SO my take,...A is best...orthostatic hypotension...from diuretic use
Reply With Quote Quick reply to this message
The above post was thanked by:
cingulate.gyrus (08-04-2012), yarasara77 (08-05-2012)
  #3  
Old 08-04-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 720
Threads: 217
Thanked 552 Times in 309 Posts
Reputation: 562
Default

Great.
Answer is A.
This elderly has sick sinus due to old age, cardiac compensation for hypotension will not occur by increasing heart rate. hence a little hypotension will make dizzy hence fluid correction
Reply With Quote Quick reply to this message
The above post was thanked by:
James Crabb (03-14-2013)



Reply

Tags
Cardiology-, Internal-Medicine-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Cancer risk in women mayursn39 USMLE Step 2 CK Forum 1 06-29-2012 12:22 AM
woman complains of feeling dizzy Novobiocin USMLE Step 2 CK Forum 7 06-23-2012 07:45 AM
Examination of a Dizzy Patient? chienpolska USMLE Step 2 CS Forum 4 05-22-2012 11:36 PM
Feeling dizzy after prostate medication! ricko335 USMLE Step 1 Forum 4 08-01-2011 09:37 AM
The systolic time in this light headed dizzy patient! earthpole USMLE Step 1 Forum 12 03-26-2011 09:58 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)