MKSAP: 74-year-old woman with altered mental status

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 74-year-old woman is evaluated in the emergency department for several hours of altered mental status. She is from out-of-state and is visiting with relatives. One of her young relatives was recently ill with gastrointestinal symptoms. The patient developed anorexia 3 days ago and vomiting 2 days ago. She has been unable to tolerate any liquid or solid foods for the last 24 hours. Medical history is significant for type 2 diabetes mellitus, hypertension, hyperlipidemia, and hypothyroidism. Medications are aspirin, lisinopril, glimepiride, levothyroxine, and atorvastatin. Her last dose of medications was 48 hours ago. On physical examination, her temperature is 37.5 °C (99.5 °F), blood pressure is 115/65 mm Hg, and pulse rate is 95/min. She is arousable but confused. Mucous membranes are dry. Her neck is supple. Cardiac examination reveals no murmurs. Her chest is clear to auscultation. Bowel sounds are present, and mild tenderness to palpation is noted throughout the abdomen. There is no rebound or guarding. There are no focal neurologic deficits. Laboratory studies are pending. Which of the following is the most likely cause of this patient’s altered mental status? A. Cerebrovascular accident B. Hypoglycemia C. Hypothyroidism D. Statin toxicity Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A soc...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Diabetes Source Type: blogs