A 32-year-old man presents with a three-month history of arthralgias


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A 32-year-old man presents with a three-month history of arthralgias, weight loss, diarrhea with fatty stools, and abdominal pain. After careful observation and testing, his physician obtains a biopsy of the lamina propria of the small intestine, which shows periodic acid-Schiff-positive material, particularly in macrophages. What is the cause of this man’s symptoms?

  • (A) Celiac sprue
  • (B) Crohn disease
  • © MALT lymphoma
  • (D) Ulcerative colitis
  • (E) Whipple disease

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A 61-year-old alcoholic presents to the emergency department with disorientation, confusion, and an unsteady gait. Horizontal nystagmus, pulmonary râles, and edematous lower extremities are noted on physical examination. On questioning, the patient states that he started drinking alcohol when he was a prisoner of war in Vietnam. His current alcohol level is within the legal limit, a toxicology screen is negative, and a stroke has been ruled out by imaging. Which of the following additional tests should be performed to estimate the extent of his disease?

  • (A) A lumbar puncture
  • (B) A transesophageal echocardiogram
  • © Coagulation studies
  • (D) Tissue pressure in the lower extremities
  • (E) Venous Doppler ultrasound imaging of the lower extremities

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