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

question 667

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. The patient is told that the diarrheal illness may have triggered his current condition, and he becomes upset that he did not seek medical attention earlier.  He inquires about the course and prognosis of his current condition.  Which of the following is the most accurate statement?

• A)Complete recovery is expected after treatment, and avoiding toxin-containing food can prevent recurrence.
• B)Some degree of persistent disability is common, and future risk of multiple sclerosis is increased.
• C)The disease progresses regardless of therapy, and median survival is about 3-5 years.
• D)The nature of the triggering event or degree of weakness at presentation does not affect prognosis.
• E)The weakness may improve spontaneously, but treatment shortens the time required for recovery.

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Definitions:

Habituation

A type of learning in which an animal becomes accustomed to a repeated, irrelevant stimulus and no longer responds to it.

Physiologically Ready

A state in which an organism or part of an organism is prepared for a specific physiological process or activity.

Sand Wasp

Insect species within the Crabronidae family, known for nesting in sandy environments and often preying upon or parasitizing other insects.

Sign Stimulus

A specific external sensory cue that triggers a fixed action pattern in an animal.