an 87-year-old woman comes to the office for a routine evalu

Discussion in 'USMLE STEP 2 CS' started by luke, Jan 6, 2011.

  1. luke

    luke Guest

    an 87-year-old woman comes to the office for a routine evaluation. She reports that she has fallen once or twice a month for the past 4 months. The falls happen at various times of the day and occur immediately after standing up or after standing for some time. She does not experience dizziness, lightheadedness, vertigo, palpitations, chest pain or tightness, focal wekaness, loss of consciusness, or injury at the time of the falls. The patient lives alone. Medical history includes hypertension and degenerative joint disease of both knees. Medications are acetaminophen and hydrochlorothiazide. On physical examination, temperature is normal, blood pressure is 135/85 mm Hg withouth postural change, pulse rate is 72/min, and respration rate is 16/min. Visual acuity with glasses is 20/40 on the right and 20/60 on the left. Cardiopulmonary examination is normal. There is bony enlargement of both knees without warmth or effusion. On balance and gait screening with the "get up and go" test, the patien must use her arms to rise from chair. Neurologic examination, including cerebellar testing and a Romberg test, is normal. The patien's score on the Mini-Mental State Examination is 26/30 (normal >= 24/30). Results of a complete blood count and blood chemistry studies are normal. Which of the following should be included as part of her management at this time?

    a. schedule 24-hour electrocardiographic monitoring

    b. prescribe hip protectors

    c. measure serum 25-hydroxyvitamin D level

    d. begin risedronate

    Can you help me?

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