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A 30-Year-Old Previously Healthy Man Comes to the Emergency Department

question 115

Multiple Choice

A 30-year-old previously healthy man comes to the emergency department due to back pain and difficulty walking. His symptoms began 4 days ago with lower back pain, which he attributed to moving furniture around his apartment. The patient also experienced a tingling sensation in his feet and hands and by the next day had difficulty walking. His weakness has gradually progressed and he has also experienced frequent episodes of palpitations, excessive sweating, and dyspnea. The patient has not travelled recently and reports no recent respiratory or gastrointestinal illness or vaccinations. He takes no medications, drinks alcohol occasionally, and does not use tobacco or illicit drugs. He has had 2 sexual partners over the past year and uses condoms inconsistently.
On examination, the patient is alert and cooperative. Bilateral pupils react sluggishly to light and accommodation. His speech is slightly dysarthric with mild weakness of the buccinators. Bilateral upper extremity motor strength is 4/5 with hyporeflexia, and bilateral lower extremity tone is decreased with 3/5 motor strength and areflexia. Vibration and proprioception sensations are reduced in the feet bilaterally. Coordination and gait testing are limited by weakness. There is no spine tenderness or neck rigidity.
Which of the following would be most helpful in establishing the diagnosis in this patient?

Definitions:

Brain

The complex organ located in the skull that is responsible for cognitive function, processing information, and controlling most of the activities of the body.

Spinal Cord

A long, thin, tubular structure made up of nervous tissue, which extends from the brainstem down the back, transmitting neural signals between the brain and the body.

Resting Potential

The difference in electric charge across the membrane of a neuron at rest, critical for the transmission of neural signals.

Positively Charged

Having a net electrical charge that is more positive due to a higher number of protons than electrons.