38-year-old hospitalized woman is evaluated for new-onset conf | Uworld | Step 2ck

38-year-old hospitalized woman is evaluated for new-onset confusion. The patient has a prolonged history of Crohn disease and was admitted 2 days ago due to worsening abdominal pain, nausea, and watery diarrhea. She tested positive for Clostridioides (formerly C/ostridium) difficile infection and is receiving oral vancomycin and intravenous fluids. Her gastrointestinal symptoms have been improving, but since yesterday the patient has been incoherent, disoriented, and unsteady. She has no other medical conditions but has had small bowel resections due to stricture and fistula in the past and has lost 10 kg (22 lbs) over the past 6 months. The patient does not use tobacco, alcohol, or illicit drugs. Temperature is 36.6 C (98 F), blood pressure is 120/70 mm Hg, and pulse is 92/min with no orthostatic changes. BMI is 19.5 kg/m2. On examination, she is not oriented to time or place. Pupils are equal and reactive to light Abduction of the right eye is limited and elicits bilateral horizontal nystagmus . Motor strength and deep tendon reflexes are normal throughout Finger-to-nose and heel-to-shin testing are normal, but the gait is wide based.