Case 15   (click here for help)

An 18 year-old student, without any medical problems, is brought to the ED after passing out during band
practice. She had been standing in 95 degree heat for nearly an hour when she began feeling dizzy and
nauseated. She slid to the ground, in a semi-sitting position since her drum set landed behind her. One
of her bandmates said she was pale and that her arms and legs jerked several times. He moved the
drums out of the way so that she was flat on the ground on her side and she quickly regained
consciousness. The paramedics found her to be alert, oriented and complaining of dizziness, with pulse
110, BP 85/50, and sinus tachycardia on the rhythm strip. They removed her heavy band jacket, placed
an IV, and brought her to the ED. She indicates she is feeling much better and wants to go home.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you
obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? How would you
monitor her condition and its treatment? What is the prognosis?

n 18 year-old student, without any medical problems, is brought to the ED after passing out during band
practice. She had been standing in 95 degree heat for nearly an hour when she began feeling dizzy and
nauseated. She slid to the ground, in a semi-sitting position since her drum set landed behind her. One
of her bandmates said she was pale and that her arms and legs jerked several times. He moved the
drums out of the way so that she was flat on the ground on her side and she quickly regained
consciousness. The paramedics found her to be alert, oriented and complaining of dizziness, with pulse
110, BP 85/50, and sinus tachycardia on the rhythm strip. They removed her heavy band jacket, placed
an IV, and brought her to the ED. She indicates she is feeling much better and wants to go home.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis. An 18 year-old student feeling dizzy and nauseated

click here for help

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