A 64-Year-Old Smoker Is Evaluated for Nagging Right Shoulder Pain

question 283

Multiple Choice

A 64-year-old smoker is evaluated for nagging right shoulder pain that radiates to the ipsilateral arm.  The patient also has weakness in the right upper extremity.  His symptoms started 2 months ago and have worsened progressively.  On neurologic examination, the patient is awake, alert, oriented, and follows commands.  He has partial right-sided ptosis with fully intact extraocular movements.  His pupils are asymmetric in dim light with 2 mm on the right and 4 mm on the left, but both are reactive to light.  The pupils become more symmetric in bright light.  The right upper extremity has 3/5 strength and absent deep tendon reflexes.  This patient's autonomic dysfunction is most likely a result of a lesion involving which of the following?

• A)Autonomic ganglia
• B)Brainstem
• C)Cerebral cortex
• D)Spinal cord
• E)Subcortical grey matter
• F)Vagus nerve

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Definitions:

Controllable

Capable of being managed, directed, or regulated by actions or interventions.

Stress

A physical, mental, or emotional response to external or internal stimuli that require adjustment or adaptation.

Secondary Appraisal

The process of evaluating one's ability to cope with or manage the consequences of a stressful event after initially recognizing it as a threat or challenge.

Stressor

Any stimulus that causes stress, invoking a physical, chemical, or emotional response.