A 24-Year-Old Man Is Brought to the Emergency Department by His

question 1059

Multiple Choice

A 24-year-old man is brought to the emergency department by his girlfriend due to progressive weakness.  They have been on a cross-country road trip for the past month.  While traveling through the midwestern United States 2 weeks ago, the patient developed diarrhea, nausea, and vomiting.  He rested, drank fluids, and improved spontaneously after 2-3 days.  However, the patient had persistent fatigue, and 4 days ago they had to stop traveling as his legs became too weak to press down the brake pedal.  He is now unable to get out of bed.  The patient has also had tingling of the hands and feet as well as shortness of breath.  He has had no fever, chills, abdominal pain, or recurrent diarrhea.  The patient has no prior medical problems and takes no medications.  He does not use tobacco, alcohol, or illicit drugs.  Temperature is 37.7 C (99.8 F) , blood pressure is 120/70 mm Hg, pulse is 90/min, and respirations are 20/min.  Pulse oximetry shows 98% on ambient air.  The patient is awake, alert, and speaking in full sentences but develops a weak cough after taking a sip of water.  The lungs are clear to auscultation and heart sounds are normal.  The abdomen is soft and nontender.  Neurologic examination shows symmetric bilateral lower extremity weakness.  Deep tendon reflexes are absent at the knees and ankles, and 1+ in the biceps and triceps.  Cranial nerve examination and sensation are normal, and he has no neck rigidity.  There is no skin rash or lymphadenopathy. Item 1 of 3
Which of the following is the best immediate step in management of this patient?

• A)Check peak expiratory flow rate
• B)Measure vital capacity at bedside
• C)Obtain arterial blood gas analysis
• D)Obtain electrodiagnostic studies
• E)Perform lumbar puncture

---

Definitions:

Content Placeholder

A predefined area in templates (especially in presentation software) where users can add their own content such as text, images, or videos.

Title Placeholder

A pre-defined area in a template or layout where the title or main heading of a document or presentation can be entered.

Color Saturation

Refers to the intensity and purity of a color, dictating how vivid, dull, or neutral a color appears.

Intensity

A measure of the strength or magnitude of an effect, characteristic, or phenomenon, often used in contexts like lighting, color, or sound.