Approach to differentiating lesions (brainstem) Quiz: Ace Your Exams

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A 54-year-old man is brought to the emergency department by ambulance after collapsing in the park about 30 minutes ago while walking with his daughter. His past medical history includes hypertension, hyperlipidemia, type 2 diabetes mellitus, and tobacco use. He is not currently taking any medication. His temperature is 37.0°C (98.6°F), pulse is 72/min, and blood pressure is 145/90 mmHg. Respirations are 8/min and are shallow and irregular, and his oxygen saturation is 87% on room air. On examination, the patient is awake and alert but is not speaking. He can look up and down but not side-to-side. His face appears slack bilaterally, and he has flaccid quadriplegia. Which of the following is the most appropriate next step in management?

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Intravenous labetalol

Magnetic resonance imaging (MRI) of the head without contrast

Endotracheal intubation and mechanical ventilation

Computerized tomography (CT) of the head without contrast

Intravenous (IV) tissue plasminogen activator (tPA)