A 62-year-old man comes to the emergency department due to painless vision loss in his left eye.  The patient states that he was watching television when suddenly everything became dark and he could not see out of his left eye.  This resolved spontaneously after approximately 5 minutes and was not associated with headache, slurred speech, numbness, or weakness.  He experienced a similar episode several months ago, at which time he did not seek medical attention.  His medical history is significant for hypertension, type II diabetes mellitus, and hyperlipidemia; he admits that he is not compliant with his medication regimen.  Two years ago, the patient was hospitalized for hyperosmolar hyperglycemic state, and his HbA1c level 4 months ago was 9.5%.  He has a 30-pack-year smoking history.  Temperature is 36.7 C (98 F), blood pressure is 160/90 mm Hg, and pulse is 80/min and regular.  Which of the following is the most likely cause of this patient's symptoms?

A 54-year-old man is brought to the emergency department after his family found him on the floor and unresponsive at home.  The patient has a history of hypertension but is not adherent with medical treatment.  He smokes cigarettes and uses cocaine.  Temperature is 36.6 C (97.9 F), blood pressure is 176/98 mm Hg, pulse is 58/min, and respirations are 12/min and irregular.  The patient is unresponsive to deep sternal rub.  The right pupil is widely dilated and unresponsive to light.  There is intermittent extended posturing of the left arm and leg.  Deep tendon reflexes are 4+ in the left extremities, and Babinski sign is present on the left side.  Which of the following is the most likely cause of this patient's current condition? A.Basal ganglia hemorrhage B.Cerebellar hemorrhage C.Medullary ischemic infarction D.Midbrain ischemic infarction E.Occipital cortex ischemic infarctionProceed To Next Item

A 62-year-old woman comes to the emergency department because of severe jaw pain. Over the past day, she has had progressively worsening pain in the right side of her jaw, which occurs predominantly when chewing and talking. A few hours ago, the vision in her right eye "totally blacked out" but returned to normal within a few minutes. She has a history of hypertension and migraines. Her only current medication is losartan. Her temperature is 37.8°C (100°F), pulse is 88/min, respirations are 18/min, and blood pressure is 126/78 mm Hg. Physical examination shows tenderness to palpation along the right jawline and right side of the scalp. Visual acuity is 20/30 bilaterally. Fundoscopic examination shows mild bilateral retinal vein dilation but no other abnormalities. There is no conjunctival injection or lacrimation. Laboratory studies show:Hemoglobin 10 mg/dLMean corpuscular volume 90 µm3Platelet count 500,000/mm3Leukocyte count 9000/mm3Erythrocyte sedimentation rate 92 mm/hWhich of the following is the most appropriate next step in the management of this patient?A. High-dose intravenous methylprednisoloneB. High-dose oral prednisoneC. Intravenous immunoglobulinD. Low-dose oral aspirinE. Low-dose oral prednisoneF. Oral methotrexateShow Explanation

An 83-year-old man is transferred to the hospital from his nursing home due to hypotension and confusion. He was previously well until yesterday morning, when the nursing staff observed that he seemed lethargic and spent the day in bed. Later that night, the staff tried to communicate with him but he was not oriented to place or time. His medical history is significant for hypertension, COPD, paroxysmal atrial fibrillation, and urinary incontinence requiring a urethral catheter. He is compliant with medications, has no recent medication changes, and has no sick contacts. On examination, his temperature is 35.4°C, his blood pressure is 68/44 mmHg, his heart rate is 88 beats per minute, and his respiratory rate is 18 breaths per minute. He is lethargic with flat neck veins; his cardiac examination is normal. His lungs are clear to auscultation, and there is no significant abdominal tenderness. His neurologic examination is normal, and his extremities are warm and well perfused. His laboratory values are significant for a leukocyte count of 13,500/mm3 and a serum lactate of 3.9 mmol/L (normal range 0.6 to 2.3 mmol/L). A urinalysis shows significant pyuria. A chest x-ray shows hyperinflated lungs but no focal opacities. Which of the following is the most appropriate next step in management?

Which condition MAINLY causes a loss of peripheral or side vision at first?CataractDiabetic retinopathyGlaucomaMacular degeneration

A 65-year-old woman comes to the physician’s office with facial pain. The pain is located along her right forehead and began 3 days ago. She describes it as constant, “burning,” and very painful with even light touch. She has never had this kind of pain before. She denies headache, photophobia, changes in vision, eye pain, pain with chewing, fever, or chills. Her past medical history is significant for migraine headaches, but this pain is different from her “typical” headaches. She also has mild hypertension and folate deficiency secondary to inadequate dietary intake. Her temperature is 37.0°C (98.6°F), pulse is 80/min, respirations are 12/min, and blood pressure is 138/90 mm Hg. There are clusters of erythematous papules and vesicles extending from her right frontal prominence down to her nasal bridge. There are small crusted erosions as well. The rash is exquisitely tender to light touch. Which of the following complications is this patient most likely to experience?