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A 74-year-old male presents to your clinic with complaints of seeing “wavy lines” in the visual field of his left eye. He is not sure when it started but does believe it has gotten progressively worse. He denies pain, photophobia, or other ocular symptoms. His PMH is significant for Type II Diabetes and HTN. His current medications include metformin and lisinopril. On examination, his visual acuity is 20/400 in the left eye and 20/70 in the right eye. His pupils are 2 mm bilaterally and equally reactive to light with accommodation. There are no extraocular motor deficits. A fundoscopic exam of his left eye is shown (see image below). What is the best next step in management of this patient?            

Full thickness tissue loss; subcutaneous fat may be visible but bone, tendon or muscle are not exposed describes what stage of a pressure ulcer?

A 74-year-old woman with PMH of hypertension, diabetes, CAD, and osteoarthritis came to the clinic with her son for assessment of her worsening cognitive decline. The son is concerned about her short-term memory problems for the past 10 months. The patient had a fall 10 months ago; after that fall, she started to ask the same questions over and over again. The patient had another fall 4 months ago and also an episode of dizziness 2 months ago. With these incidents, her son noticed further decline in cognition. Recently, her son noticed that she has become a bit more suspicious of her daughter-in-law and has been hoarding things. She has lost interest in her day-to-day activities and forgets to include the right ingredients when cooking. Family members have to remind her to take her medications, and her son is helping with the management of her finances. On the Mini-Mental Status Examination (MMSE), the patient scored 21/30 with abnormal clock drawing. On the Geriatric Depression Scale (GDS-15), the patient scored 2/15. CT scan of the head showed multiple lacunar infarcts in the right basal ganglia and left cerebellar region. Based on this information, which of the following conditions is the most likely cause of this patient’s cognitive decline?

A 76-year-old male patient with a PMH significant for osteoarthritis, presents for evaluation accompanied by his wife.  She is very concerned about some recent symptoms that he has been experiencing.  She states that her husband has begun ‘staring into space’ for lengthy periods of time, and reports that he has also had episodes of disorganized speech.  The patient has become increasingly drowsy during the day, and now frequently takes daytime naps.  Most frightening to the patient and his wife, is the occurrence of visual hallucinations.  Based on this information, which of the following conditions would be your provisional diagnosis for the patient?

An 88-year-old male complaining of abdominal pain arrives at the Emergency Department with his wife. A mini-mental status exam reveals pronounced forgetfulness and confusion. The patient is discovered to have acute appendicitis requiring immediate surgery. He is unable to understand the situation and cannot provide informed consent.  The wife of the patient is his designated Health Care Proxy.  What further action should the medical provider take?

An 82-year-old male presents to your office for follow-up of his multiple medical problems, including a history of cerebrovascular accident and dementia. The patient is bedridden and is cared for at home by his family. Examination of his sacrum reveals an area of intact skin with erythema that does not blanch with palpation. What stage decubitus ulcer is this lesion?          

You have completed comprehensive testing on an 80-year-old female and your diagnosis is Alzheimer’s dementia.  You believe that she is in the very early stages of the disease, and want to try a medication to possibly slow down progression of the disease.  Which of the following medications would you prescribe at this time?

A 74-year-old male with a PMH significant for 50-pack-year cigarette use, presents for evaluation of worsening cough and one episode of hemoptysis.  Other than nicotine stains present on his left index and middle fingers, his physical examination is unremarkable.  CXR reveals a 4 cm. right lung mass.  Serum sodium is 125 mEq/L (↓), BUN 12 mg/dL, creatinine 1.1mg/dL. Serum osmolality is 260 mOsm/L (↓), and urine sodium is 50 mEq/L (↑).  The patient’s mucous membranes are moist, skin turgor is normal, and he does not demonstrate orthostatic change in BP.  He currently takes no prescription or OTC medications or supplements.  TSH level is normal.  Based on this information, which of the following conditions is the most likely etiology of this patient’s hyponatremia?

We have discussed several relationships between variables in the ideal gas law.  Choose a pair of variables, give their relationship and provide a molecular-level description about why this is true.  (Assume other variables to be constant.). (WCSP25)   Boyle’s Law P and V Charles’ Law V and T Avogadro’s Law n and V

Concept Check: (WCSP25) a. The concentration of an aqueous solution [drop1] when water is removed by evaporation.  b. A 2.0 M solution of calcium hypochlorite, Ca(ClO)2, has a [drop2] M concentration of ClO- ions. c. Consider a chemical reaction in which strong bonds are formed and weak bonds are broken. The heat of the reaction is [drop3]. d. A reducing agent [drop4] electrons in a chemical process.  e. The limiting reactant is [drop5] in a chemical reaction. f.  When 5.0 g of KClO4 was dissolved in a solution, the temperature of the solution decreased by 1.76  ̊C. The heat of solution (ΔHsoln) for KClO4 is [drop6]. g. Select the salt that would form a precipitate when mixed with CuSO4: [drop7]