05-29-2008, 05:21 PM
****Please do each question in order to fully appreciate this stem*****
A 45-year-old man is admitted to the hospital for the evaluation of diplopia, weakness of his lower extremities, and gait difficulties. During the
interview, the patient reveals that has been forcing himself to vomit after almost every meal over the last 6 weeks. He denies associated eye
pain and discomfort, headache, or dysphagia. He has never experienced such symptoms in the past. Examination of the patient demonstrates
slight disorientation, vertical nystagmus worse on downgaze, diffuse weakness of the lower extremities, bilateral dysmetria, and hypothermia.
Laboratory analyses reveal mild dehydration and hypokalemia.
Question 1 of 5
Which of the following is the most likely diagnosis?
/ A. Anticonvulsant intoxication
/ B. Benedict syndrome
/ C. Delirium tremens
/ D. Wernicke encephalopathy
/ E. Wernicke-Korsakoff syndrome
Question 2 of 5
The patient's status has improved after an administration of a vitamin. This vitamin plays a central role in the metabolism of which of the
following compounds?
/ A. Amino acids
/ B. Carbohydrates
/ C. Cholesterol
/ D. DNA
/ E. Fatty acids
Question 3 of 5
The physiologically active form of this vitamin acts as a coenzyme for which of the following enzymes?
/ A. GIycogen phosphorylase
/ B. L-methylmalonyI-CoA mutase
/ C. Methionine synthase
/ D. Pyruvate carboxylase
/ E. Pyruvate dehydrogenase
Question 4 of 5
Which of the following would be the most appropriate initial therapy for this patient?
/ A. Chlordiazepoxide
/ B. Cyanocobalamin
/ C. GIucose
/ D. Niacin
/ E. Thiamine
Question 5 of 5
Pathologic examination of this patient's brain would most likely reveal damage to which of the following structures?
/ A. Caudate nucleus and putamen
/ B. Midline brain structures
/ C. Motoneurons in the anterior horns and cranial motor nuclei
/ D. Posterior columns and posterior roots
/ E. Substantia nigra
A 45-year-old man is admitted to the hospital for the evaluation of diplopia, weakness of his lower extremities, and gait difficulties. During the
interview, the patient reveals that has been forcing himself to vomit after almost every meal over the last 6 weeks. He denies associated eye
pain and discomfort, headache, or dysphagia. He has never experienced such symptoms in the past. Examination of the patient demonstrates
slight disorientation, vertical nystagmus worse on downgaze, diffuse weakness of the lower extremities, bilateral dysmetria, and hypothermia.
Laboratory analyses reveal mild dehydration and hypokalemia.
Question 1 of 5
Which of the following is the most likely diagnosis?
/ A. Anticonvulsant intoxication
/ B. Benedict syndrome
/ C. Delirium tremens
/ D. Wernicke encephalopathy
/ E. Wernicke-Korsakoff syndrome
Question 2 of 5
The patient's status has improved after an administration of a vitamin. This vitamin plays a central role in the metabolism of which of the
following compounds?
/ A. Amino acids
/ B. Carbohydrates
/ C. Cholesterol
/ D. DNA
/ E. Fatty acids
Question 3 of 5
The physiologically active form of this vitamin acts as a coenzyme for which of the following enzymes?
/ A. GIycogen phosphorylase
/ B. L-methylmalonyI-CoA mutase
/ C. Methionine synthase
/ D. Pyruvate carboxylase
/ E. Pyruvate dehydrogenase
Question 4 of 5
Which of the following would be the most appropriate initial therapy for this patient?
/ A. Chlordiazepoxide
/ B. Cyanocobalamin
/ C. GIucose
/ D. Niacin
/ E. Thiamine
Question 5 of 5
Pathologic examination of this patient's brain would most likely reveal damage to which of the following structures?
/ A. Caudate nucleus and putamen
/ B. Midline brain structures
/ C. Motoneurons in the anterior horns and cranial motor nuclei
/ D. Posterior columns and posterior roots
/ E. Substantia nigra