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A 34-Year-Old Man Comes to the Emergency Department Due to Difficulty

question 54

Multiple Choice

A 34-year-old man comes to the emergency department due to difficulty swallowing and blurred vision that started last night. He also reports having mild shortness of breath that started today. The patient returned to his home in Connecticut yesterday from a 7-day Caribbean trip during which he snorkeled, ate locally cured fish, and hiked in a forest. He had a mild upper respiratory illness 2 weeks ago that spontaneously resolved; otherwise, he has no other medical problems. The patient does not use tobacco, alcohol, or illicit drugs. Temperature is 37 C (98.6 F) , blood pressure is 115/70 mm Hg, and pulse is 88/min. His oral mucosa is dry and speech is slurred. Pupils are dilated and react sluggishly to light. Neck muscles are weak and he has difficulty holding his head up. Muscle strength is 1/5 in the bilateral upper limbs and 5/5 in the lower limbs. There are no sensory abnormalities. Which of the following is the most appropriate next step in management of this patient?

Definitions:

Differential White Blood Cell Count

A test that measures the percentages of different types of white blood cells in the blood, used to diagnose and monitor diseases.

Lymphocytes

A type of white blood cell integral to the immune system, with roles in adaptive immunity, including B cells and T cells.

Parasitic Worm Infection

An infestation by helminths, a group of parasitic worms, that can cause disease and malnutrition in humans.

Thrombocytes

Another term for platelets, which are blood cells involved in blood clotting.