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 BOF 121

 

   

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BOF: 121

A 63 year old male is referred to the clinic for assessment. He is accompanied by his wife who says that the patient has been getting confused and is finding it increasingly difficult to cope with simple day to day tasks. There are no significant past illnesses as far as the wife can recall and he does not recall any significant illnesses either. He is not on any medication. He smokes 20 cigarettes a day and has done so for 40 years. He takes about 12 units of alcohol a week. He was a businessman in the past but retired early. They have 2 grown up children.

On examination you note that the patient is not oriented well in place time and person and has poor recall for recent events and is unable to perform simple arithmetic.

On neurological examination you note that he his pupils react poorly to light although they do react to accommodation.

In this patient which one of the following investigations would you arrange next?

a)    HIV antibody

b)    MRI of the brain

c)     Lumbar puncture

d)    TPHA

e)    Chest X-ray

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