11-11-2003, 07:34 AM
bill - bilallll
39) A 43-year-old woman is admitted for new-onset of seizures in the setting of hyponatremia. At baseline, she is well educated and works as a computer marketer. Her medical history is remarkable for a long history of depression and alcoholism, with multiple visits to the Emergency Department for trauma. She was initially found in her hot apartment by paramedics. At that time, she was postictal, incontinent of urine, and oriented only to name. She was last seen at work 3 days ago. In the Emergency Department her systolic blood pressure is 70 mm Hg and her pulse is 130/min. Upon physical examination, she has dry mucous membranes, a jugular venous pressure of less than 5 cm, and diffuse ecchymoses on her face, body, and breasts. She proceeds to have two addition seizures in the Emergency Department that are controlled with intravenous lorazepam. Laboratory studies reveal a serum sodium of 115 mEq/L, potassium of 2.8 mEq/L, and bicarbonate of 32 mEq/L. Which of the following is the most appropriate next test to obtain?
A. Electroencephalogram (EEG)
B. Magnetic resonance imaging (MRI) of the head
C. Non-contrast computed tomography (CT) of the head
D. X-ray films of the skull
E. Lumbar puncture (LP)
Can anyone discuss this question shedding lights as to why any particular answer is chosen?
39) A 43-year-old woman is admitted for new-onset of seizures in the setting of hyponatremia. At baseline, she is well educated and works as a computer marketer. Her medical history is remarkable for a long history of depression and alcoholism, with multiple visits to the Emergency Department for trauma. She was initially found in her hot apartment by paramedics. At that time, she was postictal, incontinent of urine, and oriented only to name. She was last seen at work 3 days ago. In the Emergency Department her systolic blood pressure is 70 mm Hg and her pulse is 130/min. Upon physical examination, she has dry mucous membranes, a jugular venous pressure of less than 5 cm, and diffuse ecchymoses on her face, body, and breasts. She proceeds to have two addition seizures in the Emergency Department that are controlled with intravenous lorazepam. Laboratory studies reveal a serum sodium of 115 mEq/L, potassium of 2.8 mEq/L, and bicarbonate of 32 mEq/L. Which of the following is the most appropriate next test to obtain?
A. Electroencephalogram (EEG)
B. Magnetic resonance imaging (MRI) of the head
C. Non-contrast computed tomography (CT) of the head
D. X-ray films of the skull
E. Lumbar puncture (LP)
Can anyone discuss this question shedding lights as to why any particular answer is chosen?
A non-contrast CT is risk free, and keeps the patient and the consultants happy.