A 33-Year-Old Woman Comes to the Office with Severe Bilateral

question 357

Multiple Choice

A 33-year-old woman comes to the office with severe bilateral facial pain for the past several days.  She reports sharp, shooting pain that is confined to her cheeks and jaw, lasts several seconds, and occurs 10-20 times a day.  The pain is sometimes triggered by a cold breeze, brushing of her teeth, or chewing.  The patient has been taking ibuprofen for the pain without much relief.  She has never experienced this condition before, but 6 months ago she had numbness of her right hand that lasted about 2 weeks.  Four weeks ago, she was treated for acute sinusitis.  The patient is a primary school teacher and does not use tobacco, alcohol, or illicit drugs.  Her temperature is 36.7 C (98 F) , blood pressure is 118/82 mm Hg, pulse is 72/min, and respirations are 14/min.  On physical examination, a similar pain is elicited by lightly touching the patient's cheeks.  Otherwise, neurologic examination demonstrates no focal deficits.  Which of the following is the most likely cause of this patient's symptoms?

• A)Cerebral vasospasm involving the brainstem
• B)Demyelination of the nerve axon
• C)Nerve inflammation from viral reactivation
• D)Thrombotic occlusion of the venous sinus
• E)Viral infection of the meninges

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Definitions:

Innocent Misrepresentation

A misrepresentation made without fault or knowledge of its falsity, which may allow the misled party to void the contract but not claim damages.

Intentionally Deceptive

Deliberately misleading actions or statements designed to make someone believe something that is not true.

Ratification

The action of officially approving or confirming a previous act or decision, which was made without authorization or was otherwise questionable, to make it legally valid.

Voidable Contract

A contract that remains valid until one party, who is entitled to do so because of a defect in the contract formation, chooses to void it.