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3495 Medicine

A 58-year-old woman has a history of alcohol abuse, coronary artery disease, and atrial fibrillation. Her medications include metoprolol, lisinopril, simvastatin, and warfarin. She develops urinary urgency and frequency and is treated with oxycodone and ciprofloxacin. Three days later she develops a headache, dizziness, vomiting, and has difficulty walking. On neurological examination her strength, sensation (including vibratory sensation), and reflexes are normal. She walks with an uncoordinated, unsteady gait. On testing of coordination in the upper extremities, she displays past pointing and poor rapid alternating movements with her right upper extremity. In the lower extremities, her heel-shin testing also reveals poor coordination on the right. INR is 6.5 (normal <1, therapeutic for warfarin 2.0-3.0). What is the most likely cause of her neurologic findings?

ARight cerebellar hemorrhage
BMultiple small infarcts in the basal ganglia
CCerebellar degeneration due to chronic alcohol abuse
DPosterior column degeneration as a result of vitamin deficiency
Medicine
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3501 Medicine

A 45-year old man presented with 3-year history of a painless soft and slow growing swelling of the neck, upper trunk, upper back and shoulders. The patient had a history ofheavy alcohol consumpution and was a non-smoker. Laboratory blood analysis showed minor elevations in aspaate aminotransfe! rase (71U per liver), alanine amino-transferase (49 U per liter), and total cholesterol . Triglycerides were elevated at 1,020 mg per deciliter (11.52 mmol per liter). Magnetic resonance imgaing revealed diffuse, non-encapsulated fatty deposits in the mediastinum and in the subcutaneous and deeper fascial compaments of the neck, upper trunk and back. The probable diagnosis of the patient is –

ATuberculosis
BRheumatoid almtis
CMadelung's disease
DHodgkin's lymphoma
Medicine
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