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:

Acetabular Labrum

A ring of cartilage that surrounds the acetabulum (hip socket) enhancing its depth and stability, and cushioning the hip joint.

Anterior Cruciate Ligament

A key ligament located within the knee that connects the thigh bone (femur) to the shin bone (tibia), crucial for stabilizing the knee joint.

Tibia

A large bone located in the lower leg, also known as the shinbone, that bears much of the body’s weight.

Plantar Surface

The bottom part of the foot that comes in contact with the ground.