Hepatic encephalopathy Quiz: Ace Your Exams
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A 58-year-old woman is brought to the emergency department by her daughter who reports that the patient has been increasingly forgetful and disoriented over the past seven days. The patient has a history of alcohol-related cirrhosis and was recently discharged from the hospital after treatment for spontaneous bacterial peritonitis. Over the past week, the daughter has noticed that the patient has been sleeping during the day, which is unusual for her. At times she has been difficult to arouse. The patient has also become increasingly irritable and has had trouble completing simple tasks that were previously easy for her. Temperature is 37°C (98.6°F), pulse is 88/min, respiratory rate is 14/min, blood pressure is 118/70 mmHg, and oxygen saturation is 97% on room air. She is oriented only to person. Physical examination reveals generalized jaundice, scleral icterus, abdominal distension with shifting dullness, and spider angiomas overlying the upper chest wall. Which of the following additional physical examination findings is most likely to be seen in this patient?
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