#march2020mccqe1
A 36-year-old woman is evaluated in the emergency department for a 3-day history of confusion and falls. The patient lives alone and is accompanied by her neighbor who says that the patient's symptoms seem to be getting worse. The patient has a 10-year history of chronic alcoholism and has had recent weight loss due to diarrhea. She takes no medications. On physical examination, temperature is 35.6°C (96.0°F), blood pressure is 142/76 mm Hg, pulse rate is 90/min, respiration rate is 14/min; BMI is 17. Temporal muscle wasting, sunken supraclavicular fossae, and absent adipose stores are noted. Abdominal examination findings are normal. On neurologic examination, the patient is confused; she is unable to state the date and does not know the name of the hospital. Marked horizontal nystagmus is noted. There is no nuchal rigidity or obvious motor weakness. Deep tendon reflexes are reduced, and plantar responses are flexor. The patient has a markedly ataxic gait.
Which of the following is the best initial management?
(A) Electroencephalography
(B) Haloperidol
(C) Thiamine
(D) Vancomycin, ampicillin, and ceftriaxone
A 36-year-old woman is evaluated in the emergency department for a 3-day history of confusion and falls. The patient lives alone and is accompanied by her neighbor who says that the patient's symptoms seem to be getting worse. The patient has a 10-year history of chronic alcoholism and has had recent weight loss due to diarrhea. She takes no medications. On physical examination, temperature is 35.6°C (96.0°F), blood pressure is 142/76 mm Hg, pulse rate is 90/min, respiration rate is 14/min; BMI is 17. Temporal muscle wasting, sunken supraclavicular fossae, and absent adipose stores are noted. Abdominal examination findings are normal. On neurologic examination, the patient is confused; she is unable to state the date and does not know the name of the hospital. Marked horizontal nystagmus is noted. There is no nuchal rigidity or obvious motor weakness. Deep tendon reflexes are reduced, and plantar responses are flexor. The patient has a markedly ataxic gait.
Which of the following is the best initial management?
(A) Electroencephalography
(B) Haloperidol
(C) Thiamine
(D) Vancomycin, ampicillin, and ceftriaxone
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