There is no abdominal tenderness and no masses are detected. He is afebrile and vital signs are normal. Examination shows a healthy-appearing male who is moderately overweight. Other symptoms include upper respiratory congestion for 3 days which he has treated with an over-thecounter decongestant with some relief, constipation with no passage of stool in the past 9 days, and increasing low back pain incompletely relieved with ibuprofen, with associated weakness in both legs. The symptoms have become increasingly severe over the past week. He says that his bladder will feel full when he needs to urinate, but the urine stream is weak and his bladder does not feel as if it has emptied completely. Topic: Cauda Equina Syndrome Subject: Medicine A 65-year-old male presents with a 1-month history of problems passing urine. Begin lamotrigine (Lamictal) Answer : Dģ0. ![]() Which one of the following would be the most appropriate next step? A. His phenytoin level is therapeutic, and a CBC, metabolic profile, and magnesium level are all normal. He was wearing a cardiac monitor during one episode, but it showed nothing remarkable. He remains very drowsy for several hours after these episodes. His family states that he now has episodic confusion, sleepiness, and clumsiness, which is preceded by paresthesias and dizziness, although no tonicclonic activity has been noted. ![]() ![]() ![]() He has improved significantly and is now ambulatory. He experienced seizure activity on the second day after his stroke, but this was controlled by phenytoin (Dilantin). Topic: Seizure Subject: Medicine A 75-year-old male is brought to your office 1 month after a stroke that involved the left anterior cerebral artery, manifested by leg weakness, initial incontinence, and slowness in mentation.
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