A 65-Year-Old Man Comes to the Emergency Department Because of Severe

question 186

Multiple Choice

A 65-year-old man comes to the emergency department because of severe right thigh pain for the last 4 weeks.  Over the past two weeks, he has also noticed leg weakness that interferes with his walking.  He has never had similar symptoms before.  He had an unintentional weight loss of 15 lbs (6.8 kg) over the past 3 months.  His other medical problems include type 2 diabetes mellitus, hypertension, and hyperlipidemia.  He has no evidence of diabetic retinopathy or nephropathy.  He had a right lung lobectomy for early stage, non-small cell lung cancer 7 years ago.
He was evaluated in the emergency department on two occasions over the last 2 months for severe lightheadedness that occurred in the morning while getting out of bed.  His medications include glyburide, metformin, simvastatin, lisinopril, and low-dose aspirin.
His temperature is 37.0 C (98.6 F) , blood pressure is 145/90 mm Hg (sitting) and 120/80 mm Hg (standing) , and pulse is 90/min (sitting) and 105/min (standing) .  His BMI is 29 kg/m².  Neurological examination reveals normal mental status and cranial nerves.  Manual motor testing reveals 3/5 strength in the right iliopsoas, hip adductors, and quadriceps with associated atrophy.  Touch, pain, and temperature sensations are mildly decreased in this area.  However, the hamstrings and distal muscles have 5/5 strength.
There are no fasciculations or contractures noted.  His anal sphincter tone is normal.  Deep tendon reflexes are 2+ in the arms and 0 in the lower extremities.  Testing for Babinski sign shows down-going toes bilaterally.  The remainder of the neurological examination is within normal limits.
Laboratory results are as follows:

Which of the following is the most likely cause for this patient's current complaints?

• A)Amyotrophic lateral sclerosis
• B)Diabetic amyotrophy
• C)Extramedullary tumor with compressive myelopathy
• D)Inflammatory myopathy
• E)Lateral femoral cutaneous nerve compression

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Definitions:

Behaviorists

Behaviorists are psychologists who focus on observable behaviors as the primary subject matter of psychology, often emphasizing the role of learning in behavior.

Learning

The process of acquiring new understanding, knowledge, behaviors, skills, values, or preferences.

Modern Behaviorists

Psychologists who focus on observable and measurable behaviors, rather than internal psychological processes.

Stimuli

External factors or changes in the environment that affect the senses and can elicit responses from an organism.