A 42-Year-Old Man Comes to the Office Due to Numbness

question 49

Multiple Choice

A 42-year-old man comes to the office due to numbness and tingling in both legs and difficulty walking for the past several months.  He has also noticed that he tires more easily with physical activity.  His temperature is 36.8 C (98 F) , blood pressure is 122/86 mm Hg, pulse is 76 /min, and respirations are 14/min.  Physical examination shows conjunctival pallor and loss of vibration and position sensation in the bilateral lower extremities with associated gait ataxia.  The remainder of the examination is within normal limits.  Which of the following findings is most likely to be present upon further questioning of the patient?

• A)Ongoing treatment for latent tuberculosis
• B)Strict vegan diet for the past 6 years
• C)Total gastrectomy 8 months ago
• D)Use of an anti-epileptic drug for the past 3 months
• E)Working indoors most of the time

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Definitions:

Kotter's 8 Step Change Model

A process designed by John Kotter to facilitate organizational change, which includes creating urgency, forming a powerful coalition, and embedding new approaches into the culture.

Sense

A faculty by which the body perceives an external stimulus; one of the faculties of sight, smell, hearing, taste, and touch.

Organization

A structured arrangement of people working together to accomplish specific goals.

Geographically

Relating to the physical location or spatial characteristics of an area or place.