This article was originally presented as an independent educational activity under the direction of CME LLC. The ability to receive CME credits has expired. The article is now presented here for your reference. CME LLC is no longer responsible for the presentation of the article.
The Case
An 89-year-old hemiplegic man is seen for a routine physical examination. Major right brain stroke produced permanent dense left-sided motor deficit years ago. Has related vascular dementia. Completed full isoniazid(Drug information on isoniazid) prophylaxis for newly positive PPD skin test 2 years back; underwent concomitant pyridoxine(Drug information on pyridoxine) repletion. Has benign prostatic hyperplasia, urolithiasis, and esophageal reflux disease. Takes 14 medications, including warfarin, sotalol, tamsulosin(Drug information on tamsulosin), tizanidine for spasticity in the left hand, and quetiapine(Drug information on quetiapine).
More History/Physical
Man whose smile is evident and winning, notwithstanding left central facial palsy. Scabbed 1 cm basal cell carcinoma on right temple (neither he nor family wants it treated). Left hemiplegia. Flexion contracture at wrist, with padding and splint to prevent injury and retard progression. Verbal output sparse but mostly appropriate. Mouth as shown. Dentition and gums unremarkable for age.
Laboratory Findings
INR, 2.8 (target therapeutic range for this patient, 2 to 3).
What's Your Diagnosis?
• Addison disease
• Basal cell carcinoma
• Mucocele
• Peutz-Jeghers syndrome
• Organic psychosis
• Venus lake
(Answer on next page.)
