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37261 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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37268 Microbiology

Gram staining sequence is

ACarbol fuchsin – Iodine – Acetone – Methyl violet
BMethyl violet – Iodine – Acetone – Carbol fuchsin
CMethyl violet – Acetone – Iodine – Carbol fuchsin
DCarbol fuchsin – Acetone – Iodine – Methyl violet
Microbiology
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