JH
Forum Senior
Topics: 19
Posts: 76
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1.
A 72-year-old man comes to the physician because of a 7-month history of leg weakness and dry eyes and mouth. He also has had a 1 04-kg (23-Ib) weight loss over the past 4 months despite no change in appetite. He has smoked one and a half packs of cigarettes daily for 50 years. He drinks 4 oz of alcohol daily. He has peptic ulcer disease and emphysema. Medications include cimetidine. theophylline, and low-dose
prednisone. Examination shows mild ptosis. He has a barrel-shaped chest. Breath sounds are distant.
There is moderate weakness of the proximal muscles of the lower extremities. Reflexes are absent. He has
difficulty rising from a chair. Sensory examination shows no abnormalities. An x-ray film shows a
hyperinflated chest and a 3 x 4-cm mass in the right hilum. His neurologic findings are most likely due to a lesion involving which of the following?
A) Muscle membrane
B) Parasympathetic nervous system
C) Peripheral nerve
D) Presynaptic neuromuscular junction
E) Sympathetic nervous system
2.
A 27-year-old primigravid woman at 38 weeks' gestation is admitted in labor. Her pregnancy has been uncomplicated, and a routine prenatal visit 2 days ago showed no abnormalities. On admission, fetal heart tones cannot be heard. Ultrasonography shows little amniotic fluid, fetal edema, and no evidence of a fetal heartbeat. After 1 hour. she delivers a 31 75-g (7-Ib) stillborn infant: examination of the infant shows no obvious abnormalities except for mild edema. The placenta and membranes appear normal. Which of the following is the most appropriate immediate course of action?
A) Notify the hospital liability department
B) Obtain consent for fetal organ donation from the parents
C) Recommend autopsy of the infant
D) Tell the mother not to worry since she can get pregnant again
E) Tell the parents that there is a 1 in 4 chance of recurrence in future pregnancies
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| smal
Forum Guru
Topics: 140
Posts: 727
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1.D.
looks like eaton lambert syndrome to me.
2.C.
autopsy after obtaining a wavier(from Coroner /mother.....am not sure)
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remedy for weakness is not brooding over it ,but thinking of strength.
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| JH
Forum Senior
Topics: 19
Posts: 76
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Hi, smal, I am confused of question1 because of the explanation from the similar question of UW, which the answer is Muscle membrane. Here is the Q
A 60-year-old male presents to the office and complains of muscle weakness in his extremities. Other accompanying symptoms include progressively difficulty in performing weight-carrying tasks, and a 7 kg weight loss during the last three months. He smokes 2 packs of cigarettes daily. His muscle strength is 3/5 in the proximal muscle groups symmetrically. His reflexes are normal. No sensory abnormality is present. Chest x-ray reveals a right lower lobe ill-defined mass. Which of the following is the most likely localization of the pathologic process in this patient?
A) Peripheral nerves
B) Presynaptic membrane
C)Postsynaptic membrane
D)Muscle membrane
E)Spinal cord
the answer is: D)Muscle membrane
How would you explain this?
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| zeloc
Forum Junior
Topics: 11
Posts: 53
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The description given in the original question is classic for Eaton-Lambert, complete with the absent reflexes. It is caused by antibodies against Ca channels in the presynaptic terminal, therefore the answer is the presynaptic membrane. The Ach cannot be released to bind to the muscle membrane. Diagnosis is through electrophysiological studies and then treatment is plasmapheresis and immunosuppressive drug therapy. There are other possibilities for muscular weakness in cancer, and the UW question you describe is one of those, in which the patient has normal reflexes. It is not Eaton-Lambert.
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| Kamsi
Forum Guru
Topics: 103
Posts: 347
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| radonc
Forum Senior
Topics: 10
Posts: 180
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Agree with the first question - eaton lambert syndrome. So answer D.
What is going on with the second question??? Not sure.
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| Justice
Forum Fanatic
Topics: 117
Posts: 2,324
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D
C
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Don't live in a town where there are no doctors
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| elitoki
Forum Guru
Topics: 54
Posts: 508
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1. D, and it is Small cell Lung Cancer that is causing Eaton Lambert syndrome.
The differences between two Qs that you post is on REFLEXES!!! one is abscent (E-L synd) and another is Normal.
2. C
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| dr in trouble
Forum Guru
Topics: 62
Posts: 610
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D
C
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If u want to do something, do it today as there is no tomorrow.
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