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:

Elected Leaders

Individuals who have been chosen through a voting process to hold leadership positions, typically in political, institutional, or organizational contexts.

Empowering Leadership

A leadership style that focuses on distributing power to team members to foster autonomy, competence, and contribution.

Bureaucratic Restraints

Restrictions or limitations imposed by extensive adherence to rules and formalities within an organization.

Significant Task

A task of great importance or consequence, often requiring considerable effort or resources to accomplish.