A 62-Year-Old Caucasian Man Comes to the Physician Because of Progressive

question 776

Multiple Choice

A 62-year-old Caucasian man comes to the physician because of progressive weight loss and right lower extremity weakness for the last two months.  On further questioning, he tells you that he has been having frequent leg cramps in the right leg.  These cramps are most prominent in the morning, after he wakes up.  He also has difficulty with swallowing and chewing.  He denies any problems with bowel or bladder function.  His other medical problems include hypertension and hypercholesterolemia.  He does not use tobacco.  His family history is not significant.  His vital signs are within normal limits.  The physical examination reveals weakness in his right lower leg, atrophy and fasciculation of the thigh and calf muscles, a hyperactive knee jerk, and tongue fasciculations.  The rest of his neurological examination, including the sensory examination, is normal. Item 1 of 2
Which of the following is the most likely diagnosis?

• A)Binswanger's disease
• B)Vascular dementia
• C)Multiple sclerosis
• D)Amyotrophic lateral sclerosis
• E)Brain stem glioma

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Definitions:

Legal Challenges

Disputes or obstacles that arise in the enforcement or interpretation of laws.

Political Challenges

Issues, obstacles, or conflicts that arise in the context of governance, policy-making, or public administration that require strategic resolution.

Ethical Challenges

Situations or dilemmas that require individuals or organizations to choose actions that are morally right but may conflict with personal or societal norms.

Uncertainty-Avoidance

A cultural dimension that describes the extent to which people in a society attempt to cope with anxiety by minimizing uncertainty.