A 62-Year-Old Woman Comes to the Office Due to Progressive

question 961

Multiple Choice

A 62-year-old woman comes to the office due to progressive gait unsteadiness.  The patient's legs feel stiff, and she frequently stumbles and has to hold handrails while descending stairs.  She also has had tingling and numbness in the hands and an occasional electric shock-like sensation in the spine.  She has had no bowel or bladder incontinence.  The patient has fibromyalgia and continues to have shoulder and neck pain despite a recent dosage increase in duloxetine.  Other medical conditions include depression and hypothyroidism.  She does not use tobacco, alcohol, or illicit drugs.  Examination of the cranial nerves is normal.  Upper extremity muscle strength is decreased, with mild wasting of intrinsic hand muscles.  Lower extremity tone and reflexes are increased bilaterally.  Sensation is grossly intact.  Which of the following is the most likely cause of this patient's current condition?

• A)Demyelinating polyneuropathy
• B)Lumbar spinal stenosis
• C)Multiple sclerosis
• D)Polymyositis
• E)Spinal cord compression

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Definitions:

Pectoralis Minor

A small chest muscle that facilitates movement of the shoulder.

Scalenes

A group of muscles located in the neck, responsible for assisting with breathing and the lateral flexion and rotation of the neck.

Blood Concentration

The amount of a substance (such as glucose, electrolytes, or medication) present in a certain volume of blood.

Oxygen

A chemical element essential for cellular respiration in living organisms, and a major component of Earth's atmosphere.