karusmle
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A 62 year old women was brought to the emergency department 1 hour after a 1 minute episode of loss of consiousness , her symptoms began when she stood up after she passes a dark watery stool , she has had diarrhea and dark stools for 2 days , she has been receveving warfarin therapy for deep venous thrombosis for 2 weeks , on arival her BP is 82/60 mm hg pulse 150/min and regular , she is unable to stand , the lungs r clear to auscultation , A grade 2/6 systolic murmur is heard at the second right intercostal space with no radiation , examination shows a soft non tender abdomen , there is 1 + edema of the right lower extremity with no tenderness. so test of the stool for occult blood is positive ???
a)aortic stenosis
b)carotid sinus hypersensitivity
c)conversion reaction
d)hypertropic obstructive cardiomyopathy
e)hypoglycemia
f)mitral valve prolapse
g)orthostatic hypotension
h)pulmonary embolus
i)seizure
j)vasovagal syncope
k)vertebrobasilar insufficiency
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| AAAAA
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What is the question ?
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| achilles
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looks like a or e. whats the question karusmle.
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| karusmle
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what is the diagnosis????
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| Jinx
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a?
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| mesh
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G...orthostatic hypotension
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| Jinx
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yup it has to be orthostatic hypotension--i got confused coz i thot orthostatic has to have an autonomic cause--not so--its just hypotension occuring with postural variation--commonest cause for which is hypovolemia!!
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| AAAAA
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If you read Kaplan GI acute GI bleeding, this patient has hypotension.
In order to have orthostatic hypotension, you have to lose more than 15% of blood.
If she can not stand, she probably loses more than 30-35% or more up to 40% of blood !
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| fongch
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I believe the cause is definitely orthostatic hypotension
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| Ivonne
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 Orthostatic hypotension
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| docnikki
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I go with G
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