A 38-Year-Old Homeless Man Is Brought to the Emergency Department

question 1327

Multiple Choice

A 38-year-old homeless man is brought to the emergency department due to severe muscle pain and stiffness.  He arrived at a homeless shelter 2 days ago, and the manager says that he has been restless and irritable.  The patient has a history of alcohol abuse and injection drug use.  Temperature is 37.7 C (100 F) , blood pressure is 150/90 mm Hg, and pulse is 102/min.  Both pupils are normal, equal, and reactive to light.  There are marks on the patient's arms from previous injections as well as several abrasions and lacerations on the lower extremities.  He is unable to open his mouth completely.  Painful spasms of the neck muscles are triggered by physical stimuli.  Which of the following is the most likely cause of this patient's current condition?

• A)Immune-mediated peripheral nerve damage
• B)Impairment of presynaptic acetylcholine release
• C)Microbial invasion of the central nervous system
• D)Sudden abstinence from an opiate drug
• E)T-lymphocyte-mediated skeletal muscle injury
• F)Toxin-mediated neurotransmission blockage

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Definitions:

Interpersonal Contact

Direct interaction between two or more individuals, involving communication or physical presence.

Relationships

Connections between individuals or groups characterized by emotional or social linkage, and interactions that can influence behavior and well-being.

Neighbors

Individuals or families living near one another. The term often implies a social relationship or community connection between those living in proximity.

Testosterone Levels

The concentration of the hormone testosterone, which plays key roles in male physical characteristics and both sexes' libido.