USMLE Question of the Week

Acute Onset Visual Changes and Weakness in an Elderly Man

In Episode 53 of Med School Question of the Week for USMLE, Faustine Ramirez, MedSchoolCoach expert tutor, answers this medical school question: A 78-year-old man presents to the emergency department with 3 days of worsening confusion, fatigue, weakness, and shortness of breath. He also complains of abdominal pain, nausea, and decreased appetite, and has lost 4 lbs since his previous admission. On review of systems he endorses dizziness and visual disturbances, including blurry vision and yellow discoloration of objects around him. He has a history of congestive heart failure, hypertension, atrial fibrillation, and coronary artery disease. His medications include warfarin, furosemide, enalapril, propranolol, digoxin, aspirin, and amiodarone which he recently started. Upon arrival, his temperature is 37.5 C, heart rate is 118/min, respiratory rate is 20/min, and blood pressure is 152/83. He appears anxious and confused. He is oriented to person and place, but not to time. Pupils are 3 mm and reactive to light. Neurologic exam is otherwise unremarkable. Respirations are mildly labored. No murmurs are auscultated. Radial pulses are strong and rapid. Electrocardiogram reveals atrial tachycardia with 2:1 AV block. What is the most likely explanation for these findings?
  • DKA
  • Amiodarone toxicity
  • Brain metastasis
  • Viral encephalitis
  • Brainstem stroke
  • Digoxin toxicity
  • Hypertensive encephalopathy
  • Heart failure exacerbation
Click to Reveal the Correct Answer

Digoxin toxicity

Faustine Ramirez

Faustine graduated from the University of Washington in Seattle with a B.A. in Medical Anthropology and Global Health. She attends medical school at University of California, San Francisco where she designed and taught a course on clinical reasoning skills, developed curriculum materials for the pre-clinical pediatrics course, and led case-based sessions in pediatrics and infectious disease. She received a 253 on Step 1 and a 266 on Step 2 CK, and she scored in the 90th percentiles on all of her shelf exams.

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