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* q20
  sith - 11/12/06 16:03
20. A 72-year-old man comes to the physician because of a 7-month history of leg weakness and dry eyes and mouth. He also has had a 10.4-kg (23-lb) weight loss over the past 4 months despite no change in appetite. He has smoked one and a half packs of cigarettes daily for 50 years. He drinks 4 oz of alcohol daily. He has peptic ulcer disease and emphysema. Medications include cimetidine, theophylline, and low-dose prednisone. Examination shows mild ptosis. He has a barrel-shaped chest. Breath sounds are distant. There is moderate weakness of the proximal muscles of the lower extremities. Reflexes are absent. He has difficulty rising from a chair. Sensory examination shows no abnormalities. An x-ray film shows a hyperinflated chest and a 3 x 4-cm mass in the right hilum. His neurologic findings are most likely due to a lesion involving which of the following?

) Muscle membrane

) Parasympathetic nervous system

) Peripheral nerve

) Presynaptic neuromuscular junction

) Sympathetic nervous system
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* Re:q20
  malak - 11/12/06 16:18
  Presynaptic neuromuscular junction
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* Re:q20
  leogeorge - 11/12/06 18:08
) Presynaptic neuromuscular junction
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* Re:q20
  nida - 11/12/06 18:12
Lambert-Eaton Myasthenic syndrome
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* Re:q20
  ben - 11/12/06 18:13
) Presynaptic neuromuscular junction= Eaton lamberts --> Lung Cancer & Muscular Problsm
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* Re:q20
  nida - 11/14/06 19:28
  There is a similar Q in the UW, the answer is "Muscle membrane" instead of "Presynaptic neuromuscular junction"
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* Re:q20
  nida - 11/14/06 19:56
  I read carefully about these two Qs. The difference is the "Reflexes"

In Lambert-Eaton syndrome, reflexes is usually absent or diminished at rest, but muscular strength may improve on repetitive tasks.

Whereas in the myopathy in association with lung cancer, proximal muscles are affected, and muscle strength is diminished symmetrically. Reflexes are normal, and no sensation abnormality.

The board is really testing us from different angle !!!
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