USMLE Forum Archives - USMLE Step 3 - progressive walking difficulty X 1 day
progressive walking difficulty X 1 day
harry206 - 05-04-09 12:30
A 21-year-old Caucasian male presents to the emergency department with a history of progressive difficulty in walking for one day. He initially noticed paresthesias in his lower limbs, followed by a sense of fatigue and weakness. He can hardly walk today, and has noticed some weakness in his arms. He believes his symptoms developed while camping. He recalls taking a long hike through the woods. He denies any trauma or any recent illness (i.e., any history of headache or fever). His past medical history is insignificant. He denies the use of tobacco, alcohol, or any recreational drug use. His temperature is 36.7C(98F), blood pressure is 120/76 mm Hg, pulse is 90/min, and respirations are 16/min. Physical examination reveals prominent symmetrical paresis of the lower extremities and milder paresis of the arms. Deep tendon reflexes are decreased on both sides. A lumbar puncture is performed, and CSF analysis shows no abnormalities.
Which of the following would be most helpful in discovering the cause of this patient’s condition?
harry206 - 05-04-09 12:30
A 21-year-old Caucasian male presents to the emergency department with a history of progressive difficulty in walking for one day. He initially noticed paresthesias in his lower limbs, followed by a sense of fatigue and weakness. He can hardly walk today, and has noticed some weakness in his arms. He believes his symptoms developed while camping. He recalls taking a long hike through the woods. He denies any trauma or any recent illness (i.e., any history of headache or fever). His past medical history is insignificant. He denies the use of tobacco, alcohol, or any recreational drug use. His temperature is 36.7C(98F), blood pressure is 120/76 mm Hg, pulse is 90/min, and respirations are 16/min. Physical examination reveals prominent symmetrical paresis of the lower extremities and milder paresis of the arms. Deep tendon reflexes are decreased on both sides. A lumbar puncture is performed, and CSF analysis shows no abnormalities.
Which of the following would be most helpful in discovering the cause of this patient’s condition?
The correct answer and explanation will be available after you answer.
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#2
Re: progressive walking difficulty X 1 d bingousmle - 05-04-09 14:30 My answer is: b.
ascending lower motor neuron paralysis, acute onset...
#5
Re: progressive walking difficulty X 1 d
harry206 - 05-05-09 12:18 Explanation:
"He recalls taking a long hike through the woods"
So first step is skin examination ----> removal of tick leads to substatntial improvement.
all other steps are after this step.
Ticks symptoms develop in 5-6 days after female tick attaches to patient
Fever typically not present
Progressive ascending paralysis occur over hours to days. (in GBS it is days to weeks)
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