08-13-2008, 04:54 PM
27. An 87-year-old woman is brought to the emergency department by ambulance. Her friend found her lying in bed in her home about one-half hour ago. She had been incontinent of urine and had also vomited. The patient has a history of degenerative joint disease, hypertension and chronic obstructive pulmonary disease. The paramedics brought in her medications, which include felodipine, naproxen, albuterol inhaler, ipratropium inhaler, prednisone, theophylline and ciprofloxacin. On questioning the woman she says she has a headache and nausea, but she is not able to give a more coherent history. She appears restless, tremulous and agitated. Vital signs are: temperature 37.0°C (98.6°F), pulse 120/min, respirations 26/min and blood pressure 110/65 mm Hg. Physical examination is normal except for mild expiratory wheezing. Chest x-ray film is normal. Which of the following is the most likely cause of her symptoms?
A
) Exacerbation of chronic obstructive pulmonary disease
B
) Gastroenteritis
C
) Migraine
D
) Stroke
E
) Theophylline toxicity
A
) Exacerbation of chronic obstructive pulmonary disease
B
) Gastroenteritis
C
) Migraine
D
) Stroke
E
) Theophylline toxicity