Level 1: Dizziness – Contrasting Case #2: Patient Information

Given these changes from the original case, what is your diagnosis?

What is your diagnostic explanation?

As compared to the long case, this patient is a 65 year old man whose symptoms he describes as light headedness.

HPI: The patient thinks his heart has been beating faster than normal for at least several weeks. He believes the lightheadedness has been present for four months but is getting progressively worse. For the past two weeks he becomes severely lightheaded while walking the dog or climbing up stairs, but he has never “passed out” or fallen. History of chronic constipation but no change in severity over the last year.

PMH: No history of heart condition or congenital diseases. Does eat a low fiber diet. Never had a colonoscopy or stool occult blood test.

Physical Exam: Cardiovascular exam reveals a pulse of 103 BPM which is regular and no murmurs/gallops/rubs/clicks are appreciable. Skin, mucosal membranes and conjunctiva are pale.

Labs: Stool Occult Blood Test is positive and colonoscopy reveals a right side colonic mass. Hemoglobin of 8.5 mg/dl, low iron.