09-07-2006, 05:27 PM
An 81-year-old woman is admitted to the medical floor for depression and questionable dementia. She
has a past medical history of insulin-dependent diabetes mellitus, hypertension, and an anterior wall
myocardial infarction 10 years ago. She takes nifedipine, atenolol, insulin, aspirin, furosemide,
simvastatin, multivitamins, docusate sodium and was recently started on methylphenidate for
depression by her primary care physician. She lives at home and her family reports that she has
become increasingly withdrawn and confused over the past few months.She is an obese woman in no
distress with normal vital signs. Her neck is supple with a normal thyroid, clear lungs, and 1+ non-pitting
lower extremity edema. She is alert to person, month, but not to date or location. She has poor
concentration. In addition to evaluation of her medication list for potential causes of confusion, the most
important test to order in the evaluation of this patient's confusion is
A. calcium level
B. diffusion weighted MRI of brain
C. head CT scan with contrast
D. rapid plasma reagin test
E. thyroid stimulating hormone
has a past medical history of insulin-dependent diabetes mellitus, hypertension, and an anterior wall
myocardial infarction 10 years ago. She takes nifedipine, atenolol, insulin, aspirin, furosemide,
simvastatin, multivitamins, docusate sodium and was recently started on methylphenidate for
depression by her primary care physician. She lives at home and her family reports that she has
become increasingly withdrawn and confused over the past few months.She is an obese woman in no
distress with normal vital signs. Her neck is supple with a normal thyroid, clear lungs, and 1+ non-pitting
lower extremity edema. She is alert to person, month, but not to date or location. She has poor
concentration. In addition to evaluation of her medication list for potential causes of confusion, the most
important test to order in the evaluation of this patient's confusion is
A. calcium level
B. diffusion weighted MRI of brain
C. head CT scan with contrast
D. rapid plasma reagin test
E. thyroid stimulating hormone