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A 72-year-old man comes to the physician with his wife because of
chronic abdominal pain and headaches for 4 months. His wife states
that he has become more forgetful over the past 6 months. He has a
history of gout. He has smoked one pack of cigarettes daily for 50
years and drinks 10 oz of homemade whiskey daily. He takes no
medications. His temperature is 36.8 C (98.3 F), blood pressure is
160/98 mm Hg, pulse is 74/min, and respirations are 16/min. Neurologic
examination shows mild short-term memory loss and decreased sensation
to pinprick in the distal extremities. He has an ataxic gait. There
are gouty tophi on the dorsal aspect of the left elbow. Laboratory
studies show:


Hematocrit 33%
Mean corpuscular volume 70 μm3
Serum
Urea nitrogen (BUN) 17 mg/dL
Glucose 90 mg/dL
Creatinine 2 mg/dL
Uric acid 14 mg/dL

Which of the following is the most appropriate next step in management?

A
) Measurement of blood lead level

B
) Measurement of serum porphobilinogen level

C
) CT scan of the abdomen

D
) MRI of the brain

E
) Carbidopa-levodopa therapy

bbb. porphyria

bbbbbbbbbbbbbbbbb

explan pls

B..b/c alcohol is a mitochondrial poison..hem is made in mitochondria, so start w/ anlalysis of this like protoporphyrin level..

or porphobilinogen which is seen in cytosol, getting out from mitocondria....then in serum

mitochondria damaged..no porphobilinogen seen

whats the name of this condtion?

Erythropoietic protoporphyria ?

A I was thinking about acute intermittent porphyria but does it cause ataxia.Lead poisoning from the homemade whiskey can cause ataxia,peripheral neuropathy,abd pains,memory loss n ataxia

good explanation. lynna. I think AAA is the answer. It is typical lead poison.