A 67-Year-Old Man Is Brought to the Office Due to Progressively

question 693

Multiple Choice

A 67-year-old man is brought to the office due to progressively worsening insomnia and impaired concentration and judgment for 2 months.  Medical history is significant for early-stage non-small cell lung cancer that was resected 5 years ago.  The patient currently takes no medications.  Vitals signs are within normal limits.  On examination, he is alert and oriented.  The patient has limited language and difficulty remembering objects and names.  Horizontal nystagmus is present.  Mild spasticity, myoclonus, and hyperreflexia are present.  Gait is wide based and unsteady.  Cardiopulmonary and abdominal examinations show no abnormalities.  MRI of the head reveals cerebral atrophy and diffuse bright signals in the cortical white matter and portions of the basal ganglia; there are no mass lesions.  Which of the following is the most likely diagnosis?

• A)Carbon monoxide poisoning
• B)Leptomeningeal carcinomatosis
• C)Prion disease
• D)Thiamine deficiency
• E)Wilson disease

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Definitions:

Promissory Note

A written promise to pay a specified sum of money to a designated person at a specified date or on demand.

Indorses In Blank

A term referring to the endorsement of a negotiable financial instrument without specifying the endorsee, making it payable to the holder.

Negotiation

The process of discussing terms and conditions to reach a mutual agreement in transactions, contracts, or disputes.

Bearer Instrument

A document that entitles the person holding it to ownership or to receive the benefits it confers.