MRCP2-3002

MRCP2-3002

A 43-year-old widow presents with a one week history of progressive confusion and unsteady gait. She works as a waitress and lives in poor social circumstances.

On examination, she is malnourished and disorientated. She has nystagmus and is unable to abduct either eye. The pupils are sluggish and unequal. Ankle jerks are absent but upper limb reflexes are present.

Shortly after her admission, you are called to the ward as she has become very drowsy and has collapsed on the floor.

What is the most likely cause of her presentation and drowsiness based on the following admission investigations?

– Haemoglobin 114 g/L (115-165)
– MCV 99 fL (80-96)
– White blood count 5.6 ×109/L (4-11)
– Platelets 230 ×109/L (150-400)
– Serum sodium 129 mmol/L (137-144)
– Serum potassium 3.2 mmol/L (3.5-4.9)
– Serum bilirubin 27 µmol/L (1-22)
– Serum gamma GT 440 U/L (4-35)
– Serum alkaline phosphatase 180 U/L (45-105)
– Serum AST 90 U/L (1-31)
– Serum ALT 45 U/L (5-35)
– Serum albumin 33 g/L (37-49)
– Prothrombin time 12 secs (11.5-15.5)