A 66-year-old woman presents to the emergency department after a fall 4 hours ago. She was on her way to the bathroom when she fell to the ground and lost consciousness. Although she regained consciousness within one minute, she experienced lightheadedness for almost half an hour. She has experienced on-and-off dizziness for the past 2 weeks whenever she tries to stand. She has a history of type 2 diabetes mellitus, hypertension, hypercholesterolemia, and chronic kidney disease secondary to polycystic kidneys. Her medications include aspirin, bisoprolol, doxazosin, erythropoietin, insulin, rosuvastatin, and calcium and vitamin D supplements. She has a blood pressure of 111/74 mm Hg while supine and 84/60 mm Hg on standing, the heart rate of 48/min, the respiratory rate of 14/min, and the temperature of 37.0°C (98.6°F). CT scan of the head is unremarkable. Electrocardiogram reveals a PR interval of 250 ms. What is the next best step in the management of this patient?
ATilt table testing
BHolter monitoring
CStop antihypertensive medicines
DElectroencephalogram
EStart anti-epileptics
An experiment to determine the effects of gravity on blood pressure is conducted on 3 individuals of equal height and blood pressure oriented in different positions in space. Participant A is strapped in a supine position on a bed turned upside down in a vertical orientation with his head towards the floor and his feet towards the ceiling. Participant B is strapped in a supine position on a bed turned downwards in a vertical orientation with his head towards the ceiling and his feet just about touching the floor. Participant C is strapped in a supine position on a bed in a horizontal orientation. Blood pressure readings are then taken at the level of the head, heart, and feet from all 3 participants. Which of these positions will have the lowest recorded blood pressure reading?
AParticipant B: at the level of the feet
BParticipant A: at the level of the head
CParticipant C: at the level of the heart
DParticipant A: at the level of the feet
EParticipant C: at the level of the feet
A 33-year-old pilot is transported to the emergency department after she was involved in a cargo plane crash during a military training exercise in South Korea. She is conscious but confused. She has no history of serious illness and takes no medications. Physical examination shows numerous lacerations and ecchymoses over the face, trunk, and upper extremities. The lower extremities are cool to the touch. There is continued bleeding despite the application of firm pressure to the sites of injury. The first physiologic response to develop in this patient was most likely which of the following?
AIncreased respiratory rate
BIncreased capillary refill time
CDecreased systolic blood pressure
DDecreased urine output
EIncreased heart rate
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