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QUESTION: A 47-year-old woman with a history of hypertension presents to the ED with a severe headache that began suddenly 3 hours prior to arrival. She has a history of recurrent frontal headaches for the last month and is currently being treated for a migraine headache. Today, she also complains of blurry vision, diplopia, nausea, vomiting, and confusion. Her vital signs are BP 95/45 mm Hg, HR 118, RR 23, T 98.2°F, and pulse oximetry of 98% on room air. On exam, she appears somnolent. Neurologic exam reveals a dilated, minimally reactive left pupil, a globe that is deviated inferiorly, and bitemporal hemianopsia. Lab results only reveal hyponatremia of 129. Normal saline is administered and a CT scan reveals an intraseller mass. Which of the following is an appropriate step in the management of this patient?
A. Administer intravenous 3% saline
B. Administer intravenous hydrocortisone
C. Administer intravenous mannitol
D. Arrange for rapid radiation therapy
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