A 54-year-old male complains of loss of appetite, weakness, fatigue, and unintentional weight loss ...

The answer to question 1  ANS: A
Patients with mild renal dysfunction are generally asymptomatic, but as the disease progresses, vague symptoms appear. Fatigue and weakness are early signs, as are decreased cognitive functioning and irritability. Patients may complain of nocturia, which is due to the kidney not concentrating the urine at night. Many of these early signs are nonspecific, and patients often pass them off as a normal part of aging. GI complaints, such as nausea, vomiting, and anorexia, are common and contribute to the muscle wasting and fatigue. Patients may complain of a metallic taste in the mouth. Hypertension may develop from fluid overload and can result in CHF. Pericarditis may develop, producing a friction rub. Neurological symptoms include muscle cramps and twitching, peripheral neuropathy, difficulty concentrating, and sleep disturbances.

The answer to question 2  ANS: A
Patients who are overweight and sedentary, with a positive family history, are at high risk for developing Type 2 DM. Polydipsia, polyphagia, and polyuria are the hallmark signs of diabetes, but fatigue, weight loss, and blurred vision are often the symptoms that bring patients into the office.

The answer to question 3  ANS: B
Vertebrobasilar insufficiency is seen mostly in the elderly and is exacerbated by extension of the neck or changes in head position. There is temporary interruption of circulation in the posterior brain due to vertebral artery occlusion. Benign paroxysmal positional vertigo, or cupulolithiasis, is the most common vestibular disorder, resulting from otolithic crystals/particles detaching from the utricle membrane and migrating to the semicircular canal. It can occur spontaneously with motion or position change or as a result of vascular or labyrinth trauma. Characterized by sudden-onset dizziness lasting less than 30 seconds and following a head position change, cupulolithiasis may be accompanied by nystagmus. It usually subsides but may recur at any time. Labyrinthitis is caused by the invasion of the ear by bacteria or a virus. The bacterial version is more serious because it may lead to meningitis. Prompt treatment with antibiotics is necessary. Labyrinthitis is characterized by severe vertigo, nystagmus, and hearing loss. Suppurative labyrinthitis may be secondary to bacterial otitis media or other bacterial infection. Serous labyrinthitis can be secondary to a variety of viral illnesses, including measles, mumps, chickenpox, influenza, mononucleosis, and adenovirus.

The answer to question 4  ANS: A
Most organic dementias develop over months to years. There are typically no physical motor or sensory alterations until the condition is advanced. Memory impairment is the predominant symptom. There may be impairment in another area of cognitive functioning, such as with aphasia (producing language as well as understanding it), agnosia (perceptual impairment of environment), apraxia (inability to perform complex motor acts), and impairment in executive functioning (inability to plan, organize, sequence, and think abstractly). Ataxia is not a symptom of dementiait is a problem with gait usually due to cerebellar dysfunction.