A 32-year-old woman with alcoholism and cocaine use dating back at least 10 years comes to the emergency room after 48 h of recurrent vomiting and hematemesis. She reports abdominal discomfort that preceded the vomiting by a few days. For at least 36 h, she has been unable to keep ethanol in her stomach. Intravenous fluid replacement is started while she is being transported to the emergency room, and while in the emergency room she describes progressive blurring of vision. Over the course of 1 h, she becomes increasingly disoriented, ataxic, and dysarthric. Which of the following is the most likely explanation for her rapid deterioration?
c. Wernicke’s encephalopathy
e. Cocaine overdose
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is c; Wernicke’s encephalopathy.
Wernicke’s encephalopathy is a potentially fatal consequence of thiamine deficiency, a problem for which this woman was at risk by virtue of being an alcoholic. When she came to the emergency room, intravenous fluids were started that probably contained glucose. The stress of a large glucose load will abruptly deplete the CNS of the little thiamine it has available and will precipitate the sort of deterioration evident in this woman. Features characteristic of a Wernicke’s encephalopathy include deteriorating level of consciousness, autonomic disturbances, ocular motor problems, and gait difficulty. Autonomic disturbances may include lethal hypotension or profound hypothermia. Hemorrhagic necrosis in periventricular gray matter will be evident in this woman’s brain if she dies. The mamillary bodies are especially likely to be extensively damaged.