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 Best of Five 2.139

 

   

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BOF: 2.139

A middle-aged homeless male is brought into casualty having being found unconscious in the street.

On examination he is unkempt and is very drowsy and is just rousable to painful stimuli.

He is noted to have papilloedema but apart from this there is no gross neurological deficit, he is afebrile, there is no rash and no abnormality of his other systems.

Investigations reveal normal full blood count, urea and electrolytes and liver function tests. Blood glucose 6.2

Blood gases show pH 7.20, pCO2 3.3 kPa, pO2 12 kPa, and bicarbonate 11 mmol/L

In this patient which of the following would lead to a diagnosis:

a)      CT scan of head followed by lumbar puncture

b)      Serum methanol level

c)      Trial of intravenous thiamine

d)      CT scan of abdomen

e)      Paracetamol level in blood

 

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