03-03-2008, 05:32 AM
A 61-year-old man comes to the emergency department complaining of worsening vision over the past few weeks. Over the past 2 weeks, everything has seemed œdingy or œyellow-tinged, especially when looking at lights. He reports some associated systemic symptoms with these visual changes; he reports feeling tired, becoming easily fatigued with only moderate activity, and having occasional bouts of nausea, intermittent diarrhea, and abdominal pain. He is a poor historian, but relates a past medical history of asthma, heart disease including a myocardial infarction, atrial fibrillation, and depression. Although he is not certain of all the names of his medications, he does report using an inhaler as needed, taking a œfluid pill, two medications for his heart disease, a blood thinner for his atrial fibrillation, and a pill for depression. Vital signs are remarkable for an irregular pulse of 48/min, but are otherwise within normal limits. Ocular examination and visual acuity are normal. Physical examination reveals an S3, a displaced and diffuse point of maximal impulse, and 2+ lower extremity edema. In diagnosing the cause of this patient™s symptoms, which of the following is the most important aspect of the history to determine?
A. Amount and type of blood thinner patient normally takes
B. Cause and diagnosis of patient™s previous heart attack
C. History of glaucoma screening, family history of glaucoma
D. Medical treatment for patient™s apparent heart failure
E. Specific antidepressant prescribed for this patient
A. Amount and type of blood thinner patient normally takes
B. Cause and diagnosis of patient™s previous heart attack
C. History of glaucoma screening, family history of glaucoma
D. Medical treatment for patient™s apparent heart failure
E. Specific antidepressant prescribed for this patient