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1. A 68-year-old female presents to the emergency department with signs and symptoms of an acute ischemic stroke. The initial CT scan is normal. Her blood pressure is 164/105. What is the most appro... priate treatment for the blood pressure of this patient? A Atenolol PO B Clonidine PO C Close monitoring D Labetolol IV E Nicardipine IV Answer: C Aggressively lowering blood pressure may decrease blood flow to the ischemic tissue, thus decreasing the chances of recovery or increasing the risk of further infarction. In the setting of an acute ischemic stroke, blood pressure elevation should be monitored closely, with some elevation expected.* This elevation is expected to decline without medication in the first few hoursto days, but if elevationcontinues to a systolic blood pressure greater than 220mmHg, or mean arterial pressure greater than 120mmHg, medication is advised. Medications may includeintravenous labetolol or nicardipine, with close monitoring of the patient. After theacute phase following a stroke, appropriate oral medications may be considered for outpatient hypertension management. 2. You are evaluating a 67-year-old male with known cirrhosis of the liver secondary to alcoholic liver disease, although he has been sober for the pastyear. He is brought in to the emergency department by his daughter, who notes that for the past few days he has seemed to be more confused. On ex-amination you note the patient to be mildly confused but alert to person andplace. He has noticeable asterixis. He is not currently taking any medicationsand his blood alcohol level is undetectable. What is the treatment of choicein this case based on your physical examination findings? [Show More]

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