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MMLU / A 67-year-old woman comes to the physician because of dizziness for 6 weeks.…

Problem

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question

A 67-year-old woman comes to the physician because of dizziness for 6 weeks. When she stands up suddenly, she becomes light-headed and has to steady herself for approximately 1 to 2 minutes before she is able to walk. She has hypertension and type 2 diabetes mellitus. Current medications include glyburide, a diuretic, a β-adrenergic blocking agent, and an angiotensinconverting enzyme (ACE) inhibitor. Her pulse is 55/min. Her blood pressure is 110/70 mm Hg in the right arm and 70/50 mm Hg in the left arm while supine; her blood pressure is 70/50 mm Hg in the right arm and 50/30 mm Hg in the left arm immediately after standing. Neurologic examination shows no focal findings. An ECG shows sinus bradycardia with no evidence of ischemia. Carotid duplex ultrasonography shows reverse flow in the left vertebral artery with no evidence of occlusion. Which of the following is the most appropriate next step in management?

choices

  1. Cardiac stress scintigraphy
  2. Adjusting her medication regimen
  3. Warfarin therapy
  4. Transesophageal echocardiography

subject

professional_medicine

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Source and history

task_id
8544ebfc-92c6-577e-84a4-939ee1025bec
task_key
all--test--8544ebfc-92c6-577e-84a4-939ee1025bec
task_revision_id
1
config / split
all / test

Official source

initial import