Year Presents With Explained for Students (Easy Guide)

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How to Approach This Question

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Original Question

A 83-year-old man presents with a history of atrial fibrillation (AF), hypertension, and diabetes. His son, who accompanied the patient, states that yesterday the patient had a period when he could not speak or understand words, and that approximately 4 weeks prior he staggered against a wall and was unable to stand unaided because of weakness in his legs. He states that both instances lasted approximately a half-hour. He was unable to persuade his father to go to the emergency room either time. Medications include: Diltiazem CD 300 mg daily; lisinopril 40 mg daily; metformin 500 mg twice daily; aspirin 81 mg daily. Tobacco history: Smoked 2 packs a day; quit when he was diagnosed with hypertension. Alcohol history: Drinks 1 beer a day. Review of systems: Denies dyspnea, dizziness, or syncope; denies focal motor weakness or loss of sensation, except for the reported incident. Physical exam: Vitals: height = 70 inches; weight = 185 pounds; body mass index = 26.5; BP = 134/82 mm Hg; heart rate = 88 bpm at rest, irregularly irregular pattern. Question 1 What tests would you order? Question 2 Your EKG shows that your patient is in A-Fib. What anticoagulant therapy should be prescribed?

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