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

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Definitions:

Lower-Level Needs

Basic human requirements such as physiological needs and safety, which have to be fulfilled before higher-level needs, like self-esteem and self-actualization.

Paycheck

A check issued by an employer to an employee in payment for job services rendered, representing wages or salary.

Needs Motivation Theories

Psychological theories that explain human motivation based on the fulfillment of certain needs, such as physiological, safety, belongingness, esteem, and self-actualization needs.

Content Theories

Theories in psychology that attempt to explain specific aspects of motivation, focusing on the specific factors that motivate individuals.