MKSAP: 72-year-old unconscious woman in the ER

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old woman is evaluated in the emergency department for loss of consciousness. Her son, who brought her in, says she seemed confused and agitated when he spoke to her on the telephone less than 2 hours ago. The patient has an 8-year history of type 2 diabetes mellitus. She had strict glycemic control (average hemoglobin HbA1c level, 6.2%) until last month when she had an infected ulcer between the third and fourth toes of the right foot that resulted in amputation of the middle toe 1 week ago. According to her son, she has been depressed while recovering at home and is not eating or drinking much. Medications are glyburide, cephalexin, and ibuprofen as needed. On physical examination, temperature is 37.9 °C (100.2 °F), blood pressure is 162/96 mm Hg, pulse rate is 112/min, and respiration rate is 21/min; body mass index is 19. The patient remains unconscious and is unresponsive to noxious stimuli. Dense left hemiplegia, warmth, and profuse sweating are noted. No inguinal lymphadenopathy is observed. The right middle toe amputation is healing well without redness, discharge, or swelling. No ankle edema is noted. Which of the following is the most appropriate next step in management? A. Addition of vancomycin and ceftriaxone to the antibiotic regimen B. Fingerstick measurement of the blood glucose level C. Intravenous infusion of recombinant tissue plasmin...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Diabetes Emergency Endocrinology Source Type: blogs