Bedside Diagnostic Challenge – A 72-year-old man presents with complaint of weakness, lethargy

Paul Griner, MD, MACPBedside Diagnostic Challenge, Family Medicine, Internal Medicine

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Test your bedside diagnostic skills with this free clinical case question.

Patient Case

A 72-year-old man presents with the complaint of weakness and lethargy for about 6 months. He indicates that the weakness is more pronounced after exercise and is relieved by eating. He states that his past health has been excellent with no illnesses other than common colds. He is on no medication, has never smoked, and has a glass of wine each evening before dinner.

The review of symptoms is unremarkable except for mild constipation.

Physical examination reveals a man of stated age who appears chronically ill. He responds slowly to questions. His voice and facial expressions are normal.

  • Temperature is 95° F (35° C)
  • Blood Pressure is 142/70 mmHg
  • Pulse is 57 per minute and regular
  • Respirations are 16 per minute

The examination of organ systems reveals no abnormalities. Neurologic examination reveals delayed deep tendon reflexes.

Question

Based on the diagnostic value of careful examination …

This patient’s hypothermia is best explained by:

Answer Options:

Diminished heat production

Excessive heat loss

Impaired thermoregulation

Faulty thermometer

Answer Explanation & References:


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About The Bedside Diagnostics Blog Series:

Except for Hospitalists, Emergency Medicine physicians, and Interventional Cardiologists, most physicians will spend the bulk of their professional time with patients in an office setting.

Here is where finely tuned clinical skills are most important in leading to accurate diagnoses, fewer complications resulting from unnecessary tests and procedures, and lower costs. These Bedside Diagnostic Challenges reinforces the value of these clinical skills and tests users on their knowledge of them.

Bedside Diagnostic Challenge questions are issued periodically every month as a free benefit of Med-Challenger.

Subscribe to the Med-Challenger blog for more Diagnostic Challenge blogs and other free clinical content from Med-Challenger.

About the Author:

Paul Griner MD, MACP graduated from the University of Rochester School of Medicine and completed his residency at the Massachusetts General Hospital, Boston, MA. He has served the University of Rochester School of Medicine as Chief Resident in Medicine and as Professor, Department of Medicine. He has served as a Senior Lecturer at Harvard Medical School and consultant at the Massachusetts General Hospital where he introduced a mentoring program for the faculty of General Internal Medicine. Dr. Griner is board certified in internal medicine.