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A 60-Year-Old Right-Handed Woman with a History of Breast Cancer

question 82

Multiple Choice

A 60-year-old right-handed woman with a history of breast cancer with known spine metastasis comes to the emergency department because of headaches and mild left arm weakness. The headaches started 1 month ago and have progressively gotten worse. They occur in the right orbitofrontal region, are sharp in quality, fluctuate in intensity, and have recently been waking her from sleep. She noticed 2 weeks ago that her left arm was weaker than usual. She has taken ibuprofen, with only slight improvement of the headaches.
Her temperature is 37°C (98.6°F) , blood pressure is 130/80 mm Hg, and pulse is 90/min. Neurologic examination shows a slight left lower facial palsy and a pronator drift in the left upper extremity. Reflexes are 3+ on the left side of the body, with an ipsilateral Babinski sign. The rest of the neurologic examination shows no abnormalities.
Basic blood work is normal. An MRI of the brain with and without gadolinium shows a single ring-enhancing lesion with mild surrounding vasogenic edema and mass effect at the grey-white junction in the right frontal lobe that is diffusion-restriction negative.
Which of the following is the most appropriate next step in the management of this patient?

Definitions:

In statistics, α (alpha) typically represents the level of significance, the probability of rejecting the null hypothesis when it is actually true.

Null Hypothesis

A hypothesis that assumes no statistical significance exists in a set of given observations and that any observed difference is due to chance.

T = 1.965

A specific value often used in statistical analysis, particularly in hypothesis testing, where it represents a critical value in a t-distribution.

Critical Value

A point on the test distribution that is compared with the test statistic to decide whether to reject the null hypothesis.