06-19-2007, 06:16 PM
17. A previously healthy 24-year-old woman is
brought to the
physician by her husband because of several episodes
of loss of consciousness
over the past 4 days. Her husband reports that during
episodes, she
jerks her arms and legs wildly. Each episode lasts up
to 1 hour; between
episodes, her behavior is normal. She is planning to
move to another
state because of her husband's work. She has been
extremely anxious and
upset about the move because she will have to leave
her mother, who was
recently diagnosed with breast cancer. There is no
family history of
seizure disorder. Her temperature is 36.7 C (98 F),
blood pressure is
130/80 mm Hg, pulse is 84/min, and respirations are
18/min. Neurologic
examination shows no abnormalities.
Electroencephalography shows
normal findings during an episode of shaking. Which
of the following is the
most likely underlying cause?
A
) Catatonia
B
) Complex partial seizure
C
) Conversion reaction
D
) Dissociative fugue
E
) Malingering
F
) Tonic-clonic seizure
18. A 37-year-old man comes to the physician
because of a 3-month
history of increasing pain of his shoulders and upper
arms. Over the
past 2 weeks, he has also had difficulty lifting heavy
objects off shelves
in his garage. Two days ago, he burned his hand by
touching a hot pan
and felt little discomfort. He sustained a concussion
in a motor
vehicle collision at the age of 29 years. He has no
allergies. He takes no
medications. He does not smoke cigarettes or use
illicit drugs, and he
drinks one to two beers daily. Muscle strength is
decreased equally in
both arms. Temperature and pain sensation are
decreased in both hands,
but light touch is normal. Muscle strength and
sensation are normal in
the lower extremities. Neurologic examination shows
no other
abnormalities. Which of the following is the most
likely diagnosis?
A
) Alcoholic peripheral neuropathy
B
) Ankylosing spondylitis
C
) Guillain-Barré syndrome
D
) Herniated intervertebral disc
E
) Multiple sclerosis
F
) Polymyositis
G
) Syringomyelia
brought to the
physician by her husband because of several episodes
of loss of consciousness
over the past 4 days. Her husband reports that during
episodes, she
jerks her arms and legs wildly. Each episode lasts up
to 1 hour; between
episodes, her behavior is normal. She is planning to
move to another
state because of her husband's work. She has been
extremely anxious and
upset about the move because she will have to leave
her mother, who was
recently diagnosed with breast cancer. There is no
family history of
seizure disorder. Her temperature is 36.7 C (98 F),
blood pressure is
130/80 mm Hg, pulse is 84/min, and respirations are
18/min. Neurologic
examination shows no abnormalities.
Electroencephalography shows
normal findings during an episode of shaking. Which
of the following is the
most likely underlying cause?
A
) Catatonia
B
) Complex partial seizure
C
) Conversion reaction
D
) Dissociative fugue
E
) Malingering
F
) Tonic-clonic seizure
18. A 37-year-old man comes to the physician
because of a 3-month
history of increasing pain of his shoulders and upper
arms. Over the
past 2 weeks, he has also had difficulty lifting heavy
objects off shelves
in his garage. Two days ago, he burned his hand by
touching a hot pan
and felt little discomfort. He sustained a concussion
in a motor
vehicle collision at the age of 29 years. He has no
allergies. He takes no
medications. He does not smoke cigarettes or use
illicit drugs, and he
drinks one to two beers daily. Muscle strength is
decreased equally in
both arms. Temperature and pain sensation are
decreased in both hands,
but light touch is normal. Muscle strength and
sensation are normal in
the lower extremities. Neurologic examination shows
no other
abnormalities. Which of the following is the most
likely diagnosis?
A
) Alcoholic peripheral neuropathy
B
) Ankylosing spondylitis
C
) Guillain-Barré syndrome
D
) Herniated intervertebral disc
E
) Multiple sclerosis
F
) Polymyositis
G
) Syringomyelia