A 70-Year-Old Man Comes to the Office Due to Weakness

question 556

Multiple Choice

A 70-year-old man comes to the office due to weakness and clumsiness of his left leg.  The patient's family noticed him dragging the left foot over the past several days, and he fell when his toes caught on a step.  He has had no fever, headache, numbness, or visual disturbances.  The patient has a history of lacunar infarction causing left-sided hemiparesis several years ago, which improved with physical therapy.  His other medical problems include hypertension, type 2 diabetes mellitus, osteoarthritis, and chronic back pain attributed to osteoarthritis.  The patient has lived alone since the death of his wife 4 years ago.
Temperature is 36.7 C (98.1 F) , blood pressure is 136/88 mm Hg, pulse is 80/min, and respirations are 16/min.  Examination shows moist mucous membranes, normal jugular venous pressure, clear lung fields, and normal heart sounds.  The abdomen is soft and nontender.  Cranial nerve examination is normal.  Motor power is 5/5 in both upper and right lower extremities.  There is reduced strength of left leg abduction, left foot inversion and eversion, and toe extension.  Bilateral upper and lower extremity deep tendon reflexes are normal.  While walking, the patient flexes his left thigh higher and his left foot slaps the floor.
Which of the following is most appropriate next step in evaluation of this patient's current symptoms?

• A)CT scan of the brain
• B)Hemoglobin A1c level
• C)MRI of the lumbar spine
• D)Nerve conduction studies
• E)Serum vitamin B₁₂ level

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Definitions:

Epithelium Classified

An organization of epithelial tissues based on cell shape and layering, which serve various functions such as protection, secretion, and absorption.

Cell Layers

Stratified groups of cells forming tissues or barriers, such as in the skin or lining of the gastrointestinal tract.

Cell Shape

Cell shape refers to the three-dimensional structure of a cell, which is determined by its function and the characteristics of its membrane and cytoskeleton.

Basement Membrane

is a thin, fibrous, extracellular matrix that separates the lining of an internal or external body surface from underlying connective tissue.