A 46-Year-Old Man Comes to the Emergency Department Due to Worsening

question 19

Multiple Choice

A 46-year-old man comes to the emergency department due to worsening blurry vision, difficulty swallowing, and dry mouth for the past hour.  He has also been having nausea and abdominal discomfort but has no headache or fever.  The patient has no prior medical conditions and takes no medications.  He smokes a pack of cigarettes daily but does not use alcohol or illicit drugs.  The patient has not traveled recently but attended a community potluck event yesterday where he sampled home-canned foods.  Physical examination shows bilateral ptosis and sluggish pupillary response.  Which of the following steps in neuromuscular transmission is most likely affected in this patient?

• A)A
• B)B
• C)C
• D)D
• E)E

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Definitions:

Triethylamine

A strong, organic base with the formula (C2H5)3N, used as a catalyst and solvent in chemical synthesis.

Z Isomer

Refers to an isomer where the highest priority groups on either side of a double bond or around a ring system are on the same side, following CIP priority rules.

1-Bromopentane

An organic compound classified as an alkyl halide, consisting of a five-carbon chain with a bromine atom attached to the first carbon.

Acetone

A colorless, volatile, flammable liquid ketone, widely used as a solvent and as a precursor to other organic compounds.