QUESTION: 69

A42-year-old patient suffering from alcoholism has advanced liver disease with ascites. He is hospitalized for agitation and bizarre behavior. Which of the following findings is most helpful in making the diagnosis of hepatic encephalopathy?
In the patient above, his blood ammonia level is twice his baseline. Which of the following is a likely precipitating factor?

bleeding esophageal varices
noncompliance with diuretic therapy
excessive lactulose therapy
insufficient protein ingestion
recent alcohol ingestion

Answer(s): A

Explanation:

Hepatic encephalopathy is a syndrome of declining intellectual function, altered state of consciousness, and neurologic abnormalities in the setting of advanced liver disease. Other findings include hyperactivity, delirium, agitation, and personality changes, progressing to confusion, somnolence, and coma. Asterixis (lapses of sustained muscle contraction) or "flapping tremor" is common. Jaundice, spider angiomas, and ascites can be present in alcoholic liver disease without the presence of encephalopathy. Precipitating factors must be looked for and reversed if possible. GI bleeding (due to esophageal varices, gastritis, ulcer, and so forth) increases the nitrogen load in the gut and reduces cerebral perfusion. Excessive diuresis with prerenal azotemia increases extrahepatic circulation of urea and ammonia production, so noncompliance with diuretics would decrease ammonia levels. Lactulose acidifies the stool, traps ammonia and other nitrogenous substances, and decreases their absorption from the gut so excessive lactulose would decrease ammonia levels. Excessive protein intake is a common precipitant.

Reveal Solution Next Question

QUESTION: 70

A 78-year-old woman comes to your primary care office practice with her son who is concerned about changes in her mood. She is less interested in going out to dinner and does not want to visit family or friends. Her language skills seem to have deteriorated over the last few years and her memory is not as sharp. Her gait and motor strength are normal. Which of the following is the most likely diagnosis?

Parkinson's disease
anxiety disorder
meningioma
Alzheimer's disease
dysthymia

Answer(s): D

Explanation:

Classic features of Alzheimer's syndrome include amnestic memory impairment, deterioration of language, and visuospatial deficits. Gait disturbances and motor and sensory changes are uncommon until late phases of the syndrome. Mood change and apathy are commonly seen in early stages of Alzheimer's syndrome and typically continue for the duration of the disease. Psychotic features may be seen in middle and late phases of the syndrome.

Reveal Solution Next Question

QUESTION: 71

A44-year-old secretary presents with a fever of 103°F, headache, and stiff neck. You entertain a diagn osis of bacterial meningitis and begin antibiotics immediately. With bacterial meningitis, which of the following is a likely finding in the cerebrospinal fluid (CSF)?

leukocytes between 100 and 500/mm
CSF pressure between 100 and 120 mmH2O
negative Gram stain
glucose >120 mg/dL
protein levels >45 mg/dL

Answer(s): E

Explanation:

The Gram stain is positive in three-fourths of bacterial meningitis cases. Leukocyte counts average between 5000 and 20,000; CSF pressure is consistently elevated usually above 180 mmH2O; glucose levels are usually lower than 40 mg/dL, or less than 40% of blood glucose; and protein levels are higher than 45 mg/dL in 90% of cases

Reveal Solution Next Question

QUESTION: 72

In this otherwise healthy adult woman, what is the most likely infecting organism?

group B Streptococcus
Staphylococcus aureus
Haemophilus influenzae
Streptococcus pneumoniae
Listeria monocytogenes

Answer(s): D

Explanation:

F. pneumoniae is the most common cause of adult meningitis in people over 30 and accounts for about 15% of cases. H. influenzae is the most common cause in children over 1 month old. Group B Streptococcus is an important cause of neonatal meningitis, but is very rare in adults. Staphylococcus, E.
coli, and Klebsiella may be seen with penetrating head wounds or postneurosurgical procedures.

Reveal Solution Next Question

Free STEP2 Exam Braindumps (page: 18)

QUESTION: 69

Explanation:

QUESTION: 70

Explanation:

QUESTION: 71

Explanation:

QUESTION: 72

Explanation: