A 40-Year-Old Man Comes to the Office Due to Coughing

question 165

Multiple Choice

A 40-year-old man comes to the office due to coughing while drinking.  Over the past 2 months, the patient has been coughing when he drinks water because it "goes down the wrong pipe."  On occasion, water will come out of his nose when drinking.  Also, his speech sounds slurred and nasal.  The patient has no medical conditions and takes no medications.  On examination, there are no mucosal lesions in the oral cavity or oropharynx.  Palate elevation is sluggish on the right side.  The tongue appears thin and there are fasciculations.  When the physician taps on the chin while the mouth is slightly open, the jaw jerks forward briskly.  Which of the following is the most appropriate next step to establish a diagnosis in this patient?

• A)Acetylcholine receptor antibody
• B)Cervical spine x-ray
• C)Electromyography
• D)Muscle biopsy
• E)Serum creatine kinase level
• F)Serum toxin assay

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Definitions:

System 1 Thinking

A term from dual-process theory describing fast, automatic, and intuitive approaches to problem-solving and judgment, as opposed to slower, more deliberate thinking.

Slow Thinking System

A cognitive processing style that is deliberate, analytical, and logic-based, typically requiring more effort and time.

Concert

A musical performance in which musicians perform live for an audience, often part of a larger tour or event focusing on a specific genre or artist.

Algorithm

A finite set of well-defined instructions for solving a problem or accomplishing a task.