A 50-Year-Old Woman Comes to the Office Due to Both

question 217

Multiple Choice

A 50-year-old woman comes to the office due to both of her feet feeling "asleep."  Her symptoms have progressively worsened over the last 2 years and she occasionally stumbles while walking.  She has no fatigue, weakness, pain, or other neurologic symptoms.  The patient considers herself to be in good health and has no known medical problems.  She has an average diet and does not drink alcohol.
Vital signs and general physical examination are within normal limits.  BMI is 30 kg/m².  Neurologic examination indicates bilateral decreased sensation to light touch and pinprick extending downward from the ankles.  Ankle reflexes are absent and muscle strength is normal.
Which of the following would confirm the most likely cause of this patient's current symptoms?

• A)Folic acid level
• B)Hemoglobin A1c
• C)Serum protein electrophoresis
• D)Thyroid function tests
• E)Urine/blood testing for heavy metals

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Definitions:

Diagnosis

The identification of the nature of an illness or other problem by examination of the symptoms.

Substance Abuse

The injurious or perilous use of substances that impact cognitive functions, encompassing alcohol and illicit narcotics.

Addiction

A chronic condition characterized by compulsive engagement in rewarding stimuli, despite adverse consequences, often involving substance use or certain behaviors.

Disabilities

A condition, either physical or mental, that limits a person's movements, senses, or activities, affecting their day-to-day life and interactions.