Weakness and Dizziness 381361.A 23-year-old woman presents to the ED complaining of dizziness
and weakness for 2 days. She complains that she does not have energy to
perform her duties at work and even gets short of breath going up the stairs
to her third-floor apartment. She denies shortness of breath at rest, fevers,
nausea, vomiting, diarrhea, chest pain, headache, recent travel, or other asso-
ciated symptoms. She does not have any medical problems and takes no
medications. On further questioning, she reports that she is on day 9 of her
menstrual period, which has been heavy. Her periods are regular and last
about 10 days. Her BP is 122/75 mm Hg, HR is 108 beats per minute, tem-
perature is 98.7°F, and RR is 12 breaths per minute. Physical examination is
unremarkable except for pale conjunctiva and mild tachycardia. Which of
the following is the most appropriate initial diagnostic test?
a. Basic metabolic panel
b. Complete blood count
c. Obtain ECG
d. Obtain chest x-ray
e. Obtain chest CT with contrast
362.A 57-year-old man presents to the ED with generalized weakness and
pain, abdominal discomfort, and nausea for 2 days. On the review of systems he
also admits to recent polydipsia, polyuria, and a 10-lb weight loss. His medical
history includes hypertension for which he takes no medications. He has a
20-pack-year smoking history. The vital signs are remarkable for mild tachycar-
dia and hypertension. Laboratory results reveal a serumsodium 131 mEq/L,
potassium 3.5 mEq/L, chloride 101 mEq/L, bicarbonate 22 mEq/L, blood urea
nitrogen (BUN) 15 mg/dL, creatinine 1.1 mg/dL, glucose125 mg/dL, and serum
calcium level of 12.6 mEq/L. Which of the following is the most appropriate
next step in management?
a. Administer calcitonin
b. Start 0.9% normal saline intravenous (IV) bolus
c. Administer furosemide
d. Obtain chest radiograph
e. Obtain ECG