Now it is your turn to play doctor. Try your luck solving:

The Case of the man with no blood pressure...

Martin Khoury, a seventy-five year old man has come to see you for a routine check-up. You are his family doctor and have looked after him for many years. At times over the years you have found his blood pressure to be somewhat elevated, but never bad enough to require medicine to treat it. On this particular day, you have a second year medical student working with you. You've sent Jim (the med student) in to see Mr. Khoury whilst you were in with another patient. After a few minutes you rejoin Jim and Mr. Khoury. As you enter you are struck by both Jim's anxious face and by Mr. Khoury's massaging of his own bluish (cyanotic) looking left arm. Jim tells you with alarm that he is very worried about Mr. Khoury’s blood pressure. It had been high...about 150/95. But, and this is what alarmed Jim, every time he rechecked it, it kept going lower and lower. Indeed, Jim had checked it about ten times over the past three minutes and each time it was lower than the time before. In fact, just before you had walked in, Jim tells you that Mr. Khoury's blood pressure had become so low Jim could not even find it. Poor Mr. Khoury must be seriously ill indeed!, Jim tells you.

You look from Jim's anxious face to Mr. Khoury's bluish arm. Then you tell Mr. Khoury you will be back in a moment and you and Jim retire to the adjacent room. As Jim looks at you expectantly, you think carefully about what you are about to say and then you tell Jim which of the following:

1. Mr. Khoury is gravely ill.
2. Jim should stop trying so hard.
3. Jim should go back and see if Mr. Khoury has a heart murmur.
4. Jim should take the wax out of his ears.
5. Mr. Khoury has labile hypertension.

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