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 Best of Five 122

 

   

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BOF: 122

A 57-year-old male presents with an acute confusional state. This was preceded by a few days of headache, nausea and vomiting and visual disturbance. His GP had been treating him with an antihistamine as he had complained of itching over the last few months. The GP had also treated him a few weeks earlier for a swollen, hot, painful joint. He had prescribed NSAIDS and antibiotics.

On examination he was overweight, he looked plethoric, and cyanosed.  There was no clubbing. No murmurs, lungs clear. Liver was enlarged 3 fingerbreadths and the spleen was enlarged about 5 fingerbreadths.

No focal neurological signs.  On examination of the optic fundus engorged veins were seen.

Investigations:

Hb 22.4 g/dl

MCV 73 fl

WBC 20.3

Na 138 mmol/l

K 3.8 mmol/l

Urea 5.6 mmol/l

Creatinine 90 micromoles/l

Chloride 97 mmol/l

Bicarbonate 30 mmol/l

Calcium 2.32 Albumin 37 g/l

Phosphate 1.09 mmol/l

ESR 1 mm/1st hour

In this patient your course of action should be:

a)      Blood gas analysis followed by oxygen therapy

b)      Bone marrow examination

c)     Venesection

d)      Blood cultures followed by broad spectrum antibiotics until cultures are available

e)      CT scan and lumbar puncture

 

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