A 55-Year-Old Man Comes to the Emergency Department with Right

question 56

Multiple Choice

A 55-year-old man comes to the emergency department with right foot pain.  Three days ago, he noticed that he was tripping and falling frequently.  He initially experienced pain and tingling in his right lower leg that progressively turned into weakness 24 hours later.  Three months ago, he experienced similar pain and weakness in his left hand.  His past medical history includes type 2 diabetes mellitus, hypertension, and lumbar degenerative disk disease.
His blood pressure is 150/90 mm Hg and pulse is 90/min.  On physical examination, he has palpatory tenderness along the lumbar spine and trophic skin changes with stasis dermatitis in the lower extremities.  Cranial nerve examination is unremarkable.  Strength is 4/5 in the left hand and 3/5 in the right foot.  Motor examination is normal in all other muscle groups.  There is absence of pain and temperature sensation up to the knees with preserved vibration and proprioception.  Reflexes are normal in the upper extremities and the knees but are absent at the ankles bilaterally.  He has a steppage gait.
Which of the following is the most likely diagnosis?

• A)Amyotrophic lateral sclerosis
• B)L5 radiculopathy
• C)Lacunar stroke
• D)Mononeuritis multiplex
• E)Multiple sclerosis

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Definitions:

Skills Approach

A perspective on leadership that concentrates on the abilities and skills leaders can learn and develop, as opposed to traits they are born with.

Motivation

The process of stimulating individuals to take action towards achieving desired goals, influenced by both intrinsic and extrinsic factors.

Critical Thinking

The ability to think clearly and rationally, understanding the logical connection between ideas, and critically evaluating arguments and evidence.

Organizational Problems

Issues or challenges within a company or institution that hinder its operations or achievements of objectives.