A 55-Year-Old Man Comes to the Office Due to Difficulty

question 516

Multiple Choice

A 55-year-old man comes to the office due to difficulty chewing food over the past 2 months.  The patient initially experienced coughing while drinking liquids and has recently had difficulty ingesting solid foods.  In addition, several people have told him they have difficulty understanding his speech.  Review of systems is positive for a 5-kg (11-lb) weight loss over the past 3 months.  The patient smoked a pack of cigarettes daily for 35 years.  Temperature is 37 C (98.6 F) , blood pressure is 120/70 mm Hg, pulse is 78/min, and respirations are 14/min.  BMI is 24 kg/m².  On examination, there is pooling of secretions in the oral cavity.  Involuntary muscle twitching is noted over the chin, tongue, and upper and lower limbs.  Power is 4/5 in both upper extremities.  Deep tendon reflexes are 3+ throughout.  Bilateral Babinski is present.  Mental and sensory examinations are normal.  Which of the following is most likely present in this patient?

• A)Antibodies against postsynaptic acetylcholine receptors
• B)Antibodies against presynaptic Ca channels
• C)Brainstem compression
• D)Degeneration of corticospinal tract
• E)Inflammatory muscle disease

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