q#17 - drtaher

[ArchivalUser]

Physical examination of a 45-year-old man who looks much older than his stated age demonstrates thin
arms and legs, a swollen abdomen, red tongue, dry, thin, and slightly yellow skin, gynecomastia,
testicular atrophy, multiple spider angiomas, tremor, yellow discoloration of sclera, and shortterm
memory loss. Which of the following conditions is most strongly suggested by these
findings?
A. Bronchogenic carcinoma
B. Colon carcinoma
C. Congestive heart failure
D. Glomerulonephritis
E. Hepatic cirrhosis

[ArchivalUser]

eee

[ArchivalUser]

EE

[ArchivalUser]

eeee

[ArchivalUser]

e....

[ArchivalUser]

The correct answer is E. The physical examination is typical for an advanced alcoholic with
hepatic cirrhosis. It is important to recognize these symptoms, as these patients are notorious
for "underestimating" and even denying their alcohol use.
Bronchogenic carcinoma (choice A) typically presents with cough and/or respiratory changes, but
can present with mass effects in the chest or involvement of mediastinal nerves or vessels.
Colon cancer (choice B) typically presents with changes in the stool or bowel habits.
Congestive heart failure (choice C) is typically heralded by shortness of breath or peripheral
edema, or both.