A 45-Year-Old Man Comes to the Physician Because of Difficulty

question 565

Multiple Choice

A 45-year-old man comes to the physician because of difficulty walking.  Over the last several months, he has had increased falls due to feeling off balance.  He also has shooting and burning pains in his legs.  He does not have a recent history of fevers/chills, trauma, headache, visual changes, slurred speech, or trouble swallowing.  The patient also has no history of insect bites, skin rash, or genital lesions.  He works as a truck driver in the Mid-Atlantic region of the United States.  His temperature is 36.7 C (98 F) , blood pressure is 140/90 mm Hg, and pulse is 92/min.  His neurologic examination reveals bilateral small pupils that reduce in size with accommodation but not when exposed to bright light.  His muscle bulk and strength are normal.  He has reduced sensation to pain, temperature, vibration, and proprioception in the lower extremities.  Ankle reflexes are absent bilaterally.  He is unstable during the Romberg test.  Which of the following is most likely to establish the diagnosis?

• A)Alcohol use screening questionnaire
• B)Folic acid and vitamin B₁₂ levels
• C)Hemoglobin A_1c measurement
• D)Lyme ELISA antibody testing
• E)Testing for Treponema pallidum infection

Identify strategies for teaching patients with various health conditions and learning needs.

Understand the role of self-efficacy and motivation in patient education.

Recognize factors affecting a patient’s ability to learn including developmental stage, sociocultural background, and health literacy.

Understand the importance of appropriate teaching environments for effective learning.

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Definitions:

Axle Breaks

A mechanical failure where the rod or spindle passing through the center of a wheel or group of wheels fractures or splits, compromising vehicle safety.

Damages

Compensation awarded through legal means to a person who has suffered loss or harm due to the wrongful act of another.

Legal Rights

Entitlements or permissions granted to individuals by law, which can be defended or enforced in a court of law.

Titan Insurance

A company or brand name, potentially involved in providing insurance products and services, without specific detail, its exact nature or offerings are unclear without further context.