04-09-2007, 12:38 PM
A previously healthy 67-year-old man comes to the physician because of a 4-month history of hand weakness, intermittent tingling of the small fingers of his hands, and mild neck pain. Examination shows wasting, weakness, and fasciculations of the interossei muscles. Sensation is decreased to pinprick and vibration in the small fingers of each hand. Triceps tendon reflexes are decreased. Which of the following is the most likely diagnosis?
A ) Amyotrophic lateral sclerosis
B ) Cervical spondylosis
C ) Multiple sclerosis
D ) Myasthenia gravis
E ) Myasthenic (Lambert-Eaton) syndrome
F ) Myotonic muscular dystrophy
G ) Polymyalgia rheumatica
H ) Polymyositis
I ) Progressive neuropathic (peroneal) muscular atrophy
A 27-year-old primigravid woman at 29 weeks' gestation comes to the emergency department because of a 24-hour history of increasingly severe right-sided abdominal pain and no appetite. She has vomited twice over the past 4 hours. She has not had vaginal bleeding. Her temperature is 38.2 C (100.8 F). Examination shows exquisite tenderness of the right lateral flank and the fundus. There are no peritoneal signs. Bowel sounds are absent. The fetal heart rate is 144/min. Laboratory studies show:
Hematocrit 37%
Leukocyte count 16,000/mm3
Serum
Total bilirubin 1.1 mg/dL
Amylase 32 U/L
Lactate dehydrogenase 110 U/L
Urine WBC 3“5/hpf
Which of the following is the most likely diagnosis?
A ) Abruptio placentae
B ) Appendicitis
C ) Cholelithiasis
D ) Colitis
E ) Pyelonephritis
A ) Amyotrophic lateral sclerosis
B ) Cervical spondylosis
C ) Multiple sclerosis
D ) Myasthenia gravis
E ) Myasthenic (Lambert-Eaton) syndrome
F ) Myotonic muscular dystrophy
G ) Polymyalgia rheumatica
H ) Polymyositis
I ) Progressive neuropathic (peroneal) muscular atrophy
A 27-year-old primigravid woman at 29 weeks' gestation comes to the emergency department because of a 24-hour history of increasingly severe right-sided abdominal pain and no appetite. She has vomited twice over the past 4 hours. She has not had vaginal bleeding. Her temperature is 38.2 C (100.8 F). Examination shows exquisite tenderness of the right lateral flank and the fundus. There are no peritoneal signs. Bowel sounds are absent. The fetal heart rate is 144/min. Laboratory studies show:
Hematocrit 37%
Leukocyte count 16,000/mm3
Serum
Total bilirubin 1.1 mg/dL
Amylase 32 U/L
Lactate dehydrogenase 110 U/L
Urine WBC 3“5/hpf
Which of the following is the most likely diagnosis?
A ) Abruptio placentae
B ) Appendicitis
C ) Cholelithiasis
D ) Colitis
E ) Pyelonephritis