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Neuro-Medicine...

Topic: Adult

Created on Monday, October 27 2008 by rednucleus

Last modified on Monday, October 27 2008.

A 19-year-old man presents with bilateral resting tremor. He has blue lunulae and sun-flower cataract. Which one of the following is not an expected finding in this man?

A) Bilateral extensor planters

B) Normal corneal examination

C) Jaundice

D) Positive urine sugar with blood sugar of 82 mg/dl

E) Recurrent acute hepatitis

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This question was created on October 27, 2008 by rednucleus.
This question was last modified on October 27, 2008.

ANSWERS AND EXPLANATIONS

A) Bilateral extensor planters

This answer is correct.

The presence of solid upper motor neuron signs in Wilson's disease should strongly question this provisional diagnosis. (See References)


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B) Normal corneal examination

This answer is incorrect.

Around 2% of Wilson's patients with neurological involvement have no Kayser-Fleischer (KF) ring, while this figure drops down to 60% in those with hepatic involvement only. Note that the commonest cause of negative KF ring in those with clear-cut Wilson's is "examination by an inexperienced ophthalmologist!" (See References)


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C) Jaundice

This answer is incorrect.

From hepatic involvement or from Coomb's negative hemolytic anemia. Note that Wilson's can result in recurrent Coomb's negative hemolytic anemia. (See References)


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D) Positive urine sugar with blood sugar of 82 mg/dl

This answer is incorrect.

Wilson's disease is one of the recognized causes of proximal renal tubular acidosis. (See References)


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E) Recurrent acute hepatitis

This answer is incorrect.

The presence of recurrent unexplained acute hepatitis in young individuals should prompt the physician search for Wilson's disease. (See References)


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References:

1. Victor, M., and Ropper, A.H. (2001). Adams and Victor's Principles of Neurology, 7th Edition. McGraw-Hill, New York. (ISBN:0070674973)

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adult
Neuro-Medicine...
Question ID: 102708232
Question written by rednucleus. (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 10/27/2008
Modified: 10/27/2008
Estimated Permutations: 120