Yet again the neuroconsultant episode turned out to be nothing more than nightmare and next day you found yourself at the same old job with unfathomable gratitude and relief (neuro was such a hell ) Today , A 72-year-old female came to you complainng of general body weakness and fatigue worsening over several months, as well as intermittent, bitemporal headaches. Recently, the patient reported increased difficulty getting out of bed in the morning because of her weakness. She had a past medical history significant for hypertension and depression She denied chest pain,shortness of breath,abdominal pain,fevers or chills, dysuria, focal weakness, visual changes and blood tinged or dark stools. The patient did report a decreased appetite as well as occasional nausea over the past several weeks. Her medications include paroxetine, venlafaxine, hydrochlorothiazide and verapamil.
She also denied tobacco or alcohol use,and told you that she lived alone.
You performed the PE and found the following :
GENERAL APPEARANCE: fatigued, dehydrated,awake and alert, and in no acute discomfort.
VITAL SIGNS
Temperature 98.1 F(36.7 C)
Pulse 80 beats/minute
Blood pressure 80/40 mmHg
Respirations 18 breaths/minute
Oxygen saturation 98% on room air
Head ,Eyes & ENT: PERRL,EOMI, visual fields intact, oropharynx dry.
NECK: Supple, no jugular venous distension.
CARDIOVASCULAR: Regular rate and rhythm with murmurs or gallops.
LUNGS: Clear to auscultation bilaterally.
ABDOMEN: Soft, nontender, nondistended, hypoactive bowel sounds noted.
RECTAL: Normal tone, brown stool,hemoccult negative.
EXTREMITIES: Warm, well-perfused without clubbing, cyanosis or edema.
NEUROLOGIC: Alert and oriented to person, place and time; upper extremity and lower extremity strength 5/5 proximal and distal;sensation grosslyi ntact;delayed biceps and patellar reflexes bilaterally.
You placed the patient on the cardiac monitor, placed a peripheral intravenous line , and blood was drawn and sent for laboratory testing. A 12-lead ECG was obtained (Figure),and a1-liter intravenous bolus of normal saline was infused. The blood pressure improved to 90/50 at completion of the NS infusion. A chest radiograph demonstrated
no infiltrate, effusion or cardiomegaly. A noncontrast CT of the brain showed only age-related atrophy without evidence of hemorrhage.
Tell your differentials & suggested diagnosis . . also tell how will you proceed and confirmation of diagnosis and treatment
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