08-08-2006, 05:20 AM
4.43 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/mm, and respirations are 16/mm 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
Hematocnt 33%
Mean corpuscular volume 70 |jm3
Urea nitrogen (BUN) 17 mg/dL
Glucose 90 mg/dL
Creatmme 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 porphobilmogen level
C) CTscanofthe abdomen
^ D) MRI of the brain
O E) Carbidopa-levodopa therapy
Hematocnt 33%
Mean corpuscular volume 70 |jm3
Urea nitrogen (BUN) 17 mg/dL
Glucose 90 mg/dL
Creatmme 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 porphobilmogen level
C) CTscanofthe abdomen
^ D) MRI of the brain
O E) Carbidopa-levodopa therapy