#march2020mccqe1
A 73-year-old man is evaluated for confusion that began 2 weeks ago. He wanders aimlessly in the house, sometimes not recognizing his wife and mistaking the newspaper for his hat. He has visual hallucinations and believes he sees mice in the refrigerator. His medical history includes type 2 diabetes mellitus with painful peripheral neuropathy, coronary artery disease, depression, and heart failure. Medications are glyburide, nortriptyline, digoxin, lorazepam, metoprolol, lisinopril, aspirin, and pravastatin. He does not remember how long he has been taking these medications and if there have been any recent dosage changes. The patient drinks alcohol only occasionally, usually wine with a weekend meal. On physical examination, the patient has asterixis. Vital signs are normal; oxygen saturation is normal with the patient breathing ambient air. He is inattentive and not oriented to time or place. His score on the Mini-Mental State Examination is 13/30 (28/30 6 months ago). Results of laboratory studies, including electrolyte levels and liver chemistry and renal function studies, are normal. An MRI of the brain is normal. Which of the following is the most likely diagnosis?
(A) Alcohol hallucinosis
(B) Alzheimer dementia
(C) Depression
(D) Toxic encephalopathy (delirium)
A 73-year-old man is evaluated for confusion that began 2 weeks ago. He wanders aimlessly in the house, sometimes not recognizing his wife and mistaking the newspaper for his hat. He has visual hallucinations and believes he sees mice in the refrigerator. His medical history includes type 2 diabetes mellitus with painful peripheral neuropathy, coronary artery disease, depression, and heart failure. Medications are glyburide, nortriptyline, digoxin, lorazepam, metoprolol, lisinopril, aspirin, and pravastatin. He does not remember how long he has been taking these medications and if there have been any recent dosage changes. The patient drinks alcohol only occasionally, usually wine with a weekend meal. On physical examination, the patient has asterixis. Vital signs are normal; oxygen saturation is normal with the patient breathing ambient air. He is inattentive and not oriented to time or place. His score on the Mini-Mental State Examination is 13/30 (28/30 6 months ago). Results of laboratory studies, including electrolyte levels and liver chemistry and renal function studies, are normal. An MRI of the brain is normal. Which of the following is the most likely diagnosis?
(A) Alcohol hallucinosis
(B) Alzheimer dementia
(C) Depression
(D) Toxic encephalopathy (delirium)
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