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A 58-Year-Old Man Is Brought to the Office by His

question 292

Multiple Choice

A 58-year-old man is brought to the office by his sister due to behavioral symptoms. For the last several months, he has had changes in personality associated with increasingly bizarre behaviors. His mood has been very labile and he often says things that are nonsensical. The patient was diagnosed with HIV 25 years ago and is on antiretroviral therapy but frequently skips doses. He also has a history of hepatitis A and 2 episodes of gonorrhea. Temperature is 36.7 C (98.1 F) , blood pressure is 138/86 mm Hg, and pulse is 90/min. Oral examination shows thrush. Cranial nerve examination, motor strength, and deep tendon reflexes are normal. The patient is alert and oriented to person, place, and time. Three-item recall is normal, but the patient is unable to count backwards from 100 by 7 or to spell "world" backward. When asked to explain the meaning of "don't count your chickens before they hatch," he laughs and says, "I guess you just shouldn't count too many chickens." Laboratory results are as follows: MRI of the brain reveals ventricular enlargement and an increase in intensity in the white matter diffusely. Which of the following is the most likely cause of this patient's symptoms?

Definitions:

Management Accountant

A professional responsible for analyzing financial information to guide business strategy, planning, and decision-making.

Environmental Assurance

Commitments or policies aimed at minimizing the environmental impact of a company's operations, often part of corporate social responsibility efforts.

Production Cost Report

A Production Cost Report summarizes the total costs involved in the production process, including direct materials, direct labor, and overheads, helping businesses assess production efficiency.

Control

The process of setting standards, measuring actual performance, and taking corrective action to ensure that objectives are achieved in an organization.