Answer

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ACES for PACES

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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.

Revision Tip

Revise cirrhosis of the liver KEYS to
SUCCESS in Medicine page 268-273

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