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A 68-Year-Old Woman Comes to the Office for Evaluation of Lower

question 691

Multiple Choice

A 68-year-old woman comes to the office for evaluation of lower extremity weakness. The patient was hospitalized due to pneumonia and septic shock a month ago. She was intubated for respiratory failure at the time of admission and was treated in the intensive care unit for several days. After adequate improvement in her respiratory status, she was discharged to a physical rehabilitation facility. Since that time, the patient has had worsening lower extremity weakness that has failed to improve despite physical therapy. She also has had frequent occipital headaches and numbness and tingling in the hands and feet. The patient has a history of rheumatoid arthritis, hypertension, hypothyroidism, and right total knee replacement. She is a former smoker with a 20-pack-year history and does not drink alcohol. Blood pressure is 136/82 mm Hg and pulse is 72/min. Physical examination shows chronic joint deformities in both hands, clear lungs, normal heart sounds, and a nontender abdomen. Neurological examination reveals decreased lower extremity muscle strength, hyperactive knee reflexes, and decreased proprioception in the feet. Rapidly flicking the nail of the middle finger elicits flexion of the ipsilateral thumb. Which of the following is the most likely cause of this patient's current symptoms?

Definitions:

Neuroticism

A personality trait associated with a higher propensity for experiencing negative emotions such as anxiety, anger, and depression.

Impulsiveness

The tendency to act on a whim, displaying behavior characterized by little or no forethought, reflection, or consideration of the consequences.

Big Five

A model describing human personality traits in five broad dimensions: openness, conscientiousness, extraversion, agreeableness, and neuroticism.

Extraverted

A personality trait typified by an outgoing, sociable, and energetic disposition, often seeking stimulation and company.