Couldnot resist this for weekend though!!! - shess

[ArchivalUser]

43. You are seeing a 75-year-old woman with a history of type II diabetes mellitus who came to the emergency department because of a left facial droop, slurred speech, difficulty swallowing, and decreased balance. She woke up the day prior to admission feeling lightheaded. She had no palpitations, diaphoresis, or visual changes. She went back to bed and at noon awoke with difficulty swallowing and a sensation of her left tongue tingling. Her daughter noted softer speech with a left facial droop. The patient complained of difficulty with balance that made walking very difficult. She had no vertigo and ate without difficulty. Today she had worsened difficulties with left facial droop, difficulty swallowing, tongue tingling, and her daughter also noticed slurred speech. There are no complaints of word finding difficulties, no dysesthesia, and no headaches. Her blood pressure is 180/75 mm Hg and pulse is 65/min. She has a normal mental status examination with slurred speech. Physical examination shows weakness and decreased sensation of the left lower face. The next most appropriate action is to
A. check a glucose finger stick and send routine chemistries, cell counts, and urinalysis
B. order a brain MRI
C. order a cerebral angiogram
D. start her on heparin
E. start her on prednisone and acyclovir