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BOF: 38

A fifty-five year old man is admitted with a history of fatigue, weight loss and jaundice. His alcohol intake is sixty units a week.

On examination he has clubbing, Dupuytren’s contracture, palmar erythema, flapping tremor, parotid enlargement, spider naevi, gynaecomastia, hepatosplenomegaly.

Which of the following signs is indicative of a poor prognosis:

a)      Clubbing

b)      Parotid Enlargement

c)      Gynaecomastia

d)      Flapping Tremor

e)      Splenomegaly

Answer:

d)

The patient has alcoholic liver disease with clinical evidence of cirrhosis. The features of a poor prognosis are hepatic encephalopathy, low serum albumin concentration, and low serum sodium and prolonged prothrombin time.

 

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