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Patients with DLB often experience marked fluctuations in their alertness and level of arousal from one day to the next order chloromycetin 500mg fast delivery. In RBD, patients engage in dream enactment, thrashing about in bed or talking in their sleep. RBD can often precede the dementia and the move- ment disorder by years and is highly specific for DLB. A 72-year-old woman is referred to you for evaluation of 2 to 3 years of gradual memory loss. Although she clearly has significant difficulties with memory and slowed speech, she seems surprisingly apathetic toward her condition. She has hypertension and mild osteopenia but is otherwise healthy; she has no history of head trauma. Her Mini- Mental State Exam (MMSE) score is 21/30; her neurologic exam is normal. Laboratory evaluation for other causes of dementia is negative. Which of the following is the most appropriate diagnosis for this patient? Polypharmacy Key Concept/Objective: To know the diagnostic criteria for Alzheimer disease This patient has at least two areas of cognitive dysfunction (memory and speech), con- firmed by neuropsychological testing. She has no evidence of other disorders, such as the motor dysfunction expected with progressive supranuclear palsy or the ataxia and incon- tinence associated with normal-pressure hydrocephalus. It is unlikely that a low dose of hydrochlorothiazide would be responsible for significant cognitive dysfunction, particu- larly in the absence of laboratory abnormalities. The patient meets criteria for probable Alzheimer disease. The diagnosis of definite Alzheimer disease requires evidence of patho- logic changes in brain tissue from either biopsy or autopsy specimens. A 65-year-old man is brought in by his family for evaluation of altered cognitive function. The family members say that he is “normal” midday but sleeps poorly and frequently wanders about the house at night.

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On review of systems discount chloromycetin 250 mg otc, abdominal swelling and occasional diarrhea are noted. The physical examination is remarkable for unilateral edema and abdominal shifting dullness to percussion. Urinalysis shows no protein; liver function tests are within normal limits. Which of the following would be the most likely finding on small bowel biopsy for this patient? Intense lymphocyte infiltration of the lamina propria C. Eosinophilic invasion of the crypts on the small intestine D. Lack of plasma cells 4 GASTROENTEROLOGY 19 Key Concept/Objective: To be able to recognize intestinal lymphangiectasia This patient has classic findings of congenital intestinal lymphangiectasia. Intestinal lym- phangiectasia is often a congenital condition in which deformed lymphatics impair the transport of chylomicrons from the enterocytes to the mesenteric lymph duct. The block- age of lymphatic drainage may result in chylous ascites. Protein-losing enteropathy and lymphopenia are prominent features. In the congenital form of the disease, lymphedema of the legs or of one leg and one arm is seen. With endo- scopic examination, white villi, white nodules, and submucosal elevations may be noted. The white appearance of the mucosa is undoubtedly caused by retained chylomicron tria- cylglycerol. Double-contrast barium x-ray examination shows smooth nodular protrusions and thick mucosal folds without ulceration. On histologic examination, dilated lymphat- ics with club-shaped villi are seen. Lymphocytic infiltration of the lamina propria can be found in other disorders, such as lymphomas and immunoproliferative disease of the small intestine.

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