#august2020mccqe1
A 75-year-old woman with an 8-hour history of aphasia and right-sided weakness is admitted to the hospital. She has a 35-year history of hypertension treated with chlorthalidone and a 10-year history of hyperlipidemia treated with simvastatin. Her medical history is otherwise unremarkable, and she takes no other medications. On physical examination she is afebrile, blood pressure is 150/90 mm Hg, pulse rate is 88/min, and respiration rate is 12/min. Oxygen saturation on pulse oximetry is 96%. She is alert but has expressive aphasia and dense right hemiplegia. No carotid bruits are heard, and the cardiopulmonary examination is normal.
Coagulation studies, serum electrolytes, and comprehensive metabolic panel are normal. The electrocardiogram shows sinus rhythm without evidence of ischemia. The CT scan shows no signs of hemorrhage. Echocardiography is normal with an estimated ejection fraction of 54%. Which of the following is the most appropriate next step in this patient's hospital management?
(A) Bed rest for the next 48 hours
(B) Bed rest for the next week
(C) Begin a mechanical soft diet
(D) Begin physical and occupational therapy
A 75-year-old woman with an 8-hour history of aphasia and right-sided weakness is admitted to the hospital. She has a 35-year history of hypertension treated with chlorthalidone and a 10-year history of hyperlipidemia treated with simvastatin. Her medical history is otherwise unremarkable, and she takes no other medications. On physical examination she is afebrile, blood pressure is 150/90 mm Hg, pulse rate is 88/min, and respiration rate is 12/min. Oxygen saturation on pulse oximetry is 96%. She is alert but has expressive aphasia and dense right hemiplegia. No carotid bruits are heard, and the cardiopulmonary examination is normal.
Coagulation studies, serum electrolytes, and comprehensive metabolic panel are normal. The electrocardiogram shows sinus rhythm without evidence of ischemia. The CT scan shows no signs of hemorrhage. Echocardiography is normal with an estimated ejection fraction of 54%. Which of the following is the most appropriate next step in this patient's hospital management?
(A) Bed rest for the next 48 hours
(B) Bed rest for the next week
(C) Begin a mechanical soft diet
(D) Begin physical and occupational therapy
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