sunny2
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Taenia Solium a 53 years old female has muscular weakness since July, she has a history of having high blood pressure since June 1995 for which she is on ACE inhibitors. BP- 140/80, pulse-64,RR-13. Muscle power decreased B/L and sluggish ankle reflex. Serum Creatinine Kinase is Increased. What is the most appropriate next step in management of Taenia Solium ?
1.MRI
2.Detect Captopril Level
3.Blood Sugar Level
4.TSH Level
5.Muscle Biopsy
6.EEG
7.Electromyogram
8.Metronidazole
9.CT scan
10.Stool test
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| study_ing
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hmm..no potassium levels?
perhaps 5. a muscle biopsy wud help.
cant recall what an EEMG wud help differntiate..
nice thinking question sunny2
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| AAAAA
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5
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seeking study partner in USMLE, Canadian MCC OSCE examination
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| study_ing
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AAAA what wud we be looking for in it?
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| GDS2008
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Completely clueless. Initially there were two things that came in my mind -- Diabetic neuropathy (3. Blood sugar elvel) and Hyperkalemia due to ACE therapy (2. Captopril level). However, Serum creatine kinase is elevated whihc would point towards somesort of a myopathy (hypokalemia can cause myoapthy, but ACE inhivitrs cause hyperkalemia). This left me thinking about the diagnosis. Muscle biopsy as the next step seems too aggressive but may be the right answer. If we look at it scientifically, there is a temporal relationship between the develpment of HTN, start of ACE therapy and weakness, so it may very well be a drug reaction. The problem is that at least I am not aware of ACE inhibitor causing such symptoms. On a different note, hypothyroidism can also casue myopathy (check serum TSH). I do not know the answer, I am just thinking loud here. This question has left me thinking......
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| shumaila
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muscle biopsy
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| GDS2008
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I will check 4. TSH levels first
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| frank100
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5, but totally lost
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| GDS2008
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mr. sunny would you bekind enough to shed some light??
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| sunny2
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Muscle Biopsy is not the right choice !
Muscle biopsy wld hve been a rt. choice in polymyositis, even that too is associated with proximal myopathy and muscle pain and wld not have explained the sluggish tendon reflex this patient is having.
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| GDS2008
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Mr. Sunny my answer was 4. TSH levels. What about that??
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| sunny2
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GDS2008, very good thought....it is the RIGHT ANSWER.
Hypothyroidism should allways be considered in patients with an unexplained elevation of serum CK concentration and Myopathy.
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| GDS2008
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It was a very good question as well with excellent distractors. Did you make it yourself??
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| sunny2
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I get concepts from the material and twist the question with false distractors for me this way i remember the message and when i ask somone in my style it goes even more deep....try doing that urself...it works...make questions and i bet u wld not forget the answer ever 
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| study_ing
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hmm so the ace onhibitor was a red herring. good one!
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| GDS2008
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excellent!
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