History An 85-year-old woman is investigated by her general practitioner (GP) for increasing tiredness, which has developed over the past 6 months. She has lost her appetite and feels constantly nauseated. She has lost about 8 kg in weight over the past 6 months. For the last 4 weeks, she has also complained of generalized itching and cramps. She has been hypertensive for 20 years and has been on antihypertensive medication for that time.
She has had two cerebrovascular accidents, which have left her with some left side weakness and reduced mobility. Examination Her conjunctivae are pale. Her pulse is 88/min regular, blood pressure 190/110 mmHg; mild pitting edema of her ankles is present. Otherwise, examination of her cardiovascular and respiratory systems is normal. Neurological examination shows a left upper motor neuron facial palsy with mild weakness and increased tone and…
