tamriko
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A 62-year-old woman comes to the clinic complaining of weakness and
easy fatigability. Additionally, for the last few months she has suffered
from a dry mouth and dizziness when she stands up quickly. The weakness seems to be mainly in her proximal muscles, as she reports weakness lifting herself from a seated position or with brushing her hair. She denies any muscle pains or facial rash, but does note that she has developed a spotted rash across her chest. The only thing she has found to help her weakness is to “just keep at it.” Repeated effort seems to improve her symptoms, whereas she derives little immediate benefit from rest. Further, her weakness seems worse in the morning and improves throughout the day. Past medical history is remarkable
for chronic bronchitis from an 80 pack-year history of tobacco use, hypertension, and dyslipidemia. Review of systems reveals a worsening cough, mild pleuritic chest pain, and an unintentional 30-pound weight loss over the past 3 months. Physical examination reveals normal muscle tone and bulk but marked proximal muscle weakness. A diffuse, macular pattern of depigmentation is present across the patient’s thorax. Which of the following is the most likely cause of this patient’s weakness?
A. Antibody-mediated destruction of presynaptic calcium channels
B. Immune-mediated nicotinic acetylcholine receptor blockade
C. Metabolic abnormalities and muscle wasting from cachexia
D. Metastatic central nervous system involvement from undiagnosed
small cell cancer
E. Occult tumor production of a parathyroid-like hormone
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| ELM
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A here. Where is these qs from pppppppplease?
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| tamriko
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Ok ELM, I have downloaded these questions from some forum. It was forum for IMG, I don't remember exactly which one.
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| ELM
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Thank you.
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| mash
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A) eaton lambert(hx of ms weakness dat improves with effort; dizziness; postural hypotension, dry mouth )
pt has most likely ca lung( hx of smoking, wt loss )
what could be the cause of depigmented rash on chest?
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| ELM
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Dermatomyositis is one of the PNeoplastic Sx that strongly associated with small cell lung, could be that.But in dermatomyositis rash is usually erythematous, it's it?
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| tamriko
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The patient has vitiligo. New-onset vitiligo is associated with autoimmune disease.
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| ELM
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No kidding?
What is the answer?
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| tamriko
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This patient has Lambert-Eaton myasthenic syndrome. A diffuse, macular pattern of depigmentation is vitiligo.
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