A 65-Year-Old Man Is Evaluated for a 6-Month History of Unsteady

question 368

Multiple Choice

A 65-year-old man is evaluated for a 6-month history of unsteady gait.  His balance has become so poor that he requires the use of a cane.  The patient also has paresthesias in his hands and feet, which started a year ago.  He has a medical history of lumbar spinal stenosis, hypertension, and hyperlipidemia.  The patient has a 30-pack-year smoking history and does not use alcohol or illicit drugs.
Blood pressure is 143/90 mm Hg and heart rate is 82/min.  Neurologic examination reveals a distal greater than proximal reduction in pain and temperature sensation, vibration, and proprioception in the lower and upper extremities.  Muscle bulk, tone, and strength are normal.  Ankle reflexes are absent with downgoing plantar responses.  His gait is high-stepping, and Romberg sign is positive.  Laboratory results are as follows:
Which of the following tests is most likely to establish the diagnosis in this patient?

• A)Lumbar puncture
• B)Lyme disease serology
• C)MRI of the brain and spine
• D)Serum immunofixation electrophoresis
• E)Urine and blood for porphyrins

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Definitions:

Drawee

The party in a financial transaction, such as a check or draft, upon whom the order to pay is made; typically a bank.

Presenter's Warranties

Guarantees provided by the individual or entity presenting a document (e.g., a check or draft) indicating its authenticity and validity.

Payment

The transfer of money or goods from one party to another in exchange for goods, services, or to fulfill a legal obligation.

Acceptance

In contract law, the expression of assent to the terms of an offer in such a manner that a binding contract is formed between the parties.