A 50-year-old alcoholic is brought to hospital in a drowsy, confused state. On examination, his sclerae are icteric, and the liver span is normal. He is disoriented to time and place. There is limited abduction of both eyes and limited upward movement of the left eye. The pupils are equal and react normally to light. Slow, irregular nystagmus is present in all directions. He is grossly ataxic and unable to stand or walk without support. He had pulmonary tuberculosis at age 26. At age 32, he was treated for syphilis, and syphilis serology (VDRL) has been positive on several occasions since then. Which one of the following is the most likely diagnosis?
Alcoholic cerebellar degeneration.
Wernicke encephalopathy.
Neurosyphilis.
Tuberculous cerebellar abscess.
Pontine stroke
A 58-year-old man complains of recurrent, burning epigastric pain for the last 2 months. The pain is worse in the morning and is usually alleviated after a meal. He has a 20 pack-year history of smoking. He takes no medication. Physical examination is unremarkable. Which one of the following is the most appropriate investigation?
Upper gastrointestinal endoscopy
24-hour pH monitoring
Computed tomography of the abdomen
Colonoscopy
Abdominal ultrasound
A 16-year-old woman presents to the Emergency Department with constant abdominal pain and vaginal bleeding which began 2 days ago and has been increasing in severity. On examination, an abdominal mass is found which reaches from her pelvis almost to her xiphisternum. She cannot remember her last menstrual period. An ultrasound reveals an enlarged uterus which contains a fetus consistent with 36 weeks’ gestation. She admits to using cocaine. She is found to be Rh negative. Which one of the following is the correct management of this patient to prevent Rh isoimmunization?
Administer 300 mcg of RHIG (Rh immunoglobulin) now.
Give the usual dose of RHIG and order a Betke Kleihauer test to determine if additional RHIG is required.
Check the blood type of the patient’s boyfriend and administer RHIG only if he is Rh positive.
If it is more than 72 hours since the severe pain began it is too late to give RHIG.
Check the baby’s blood type after it is delivered and administer RHIG to the mother only if the fetus is Rh negative.