ling
Forum Senior
Topics: 23
Posts: 46
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. 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 10.4-kg (23-lb) 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
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| robin082006
Forum Hero
Topics: 471
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A--> Muscle membrane
exactly a q in UW
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| robin082006
Forum Hero
Topics: 471
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D may be the answer (Eaton Lambert), but not most common of paraneoplastic syndrome
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The Key to Succeed is Patience.
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| ALS
Forum Senior
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Posts: 190
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D: presynaptic NM junction
it is Eaton-lambert syndrome.(Hint romixmal muscle weakness, decreased deep tendon reflex, small cell lung cancer)
To differentiate from Myasthesia Gravis is MG DTR is relativel preserved and more obvious facial muscle involvement.
right?
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| Aashi
Forum Moderator
Topics: 113
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IN LUNG CA we can see myopathies---> paraneoplastic syndrome( problems in muscle membrane) here also we do have prox muscle weaknes,,but NORMAL reflex and no sensory problems
Eaton lambert syndrome--> weakness of prox muscles, and loss of deep tendon reflex and increased energy after working up the muscle….and hx of lung ca--->abs against voltage gated calcium channels( presynaptic)
This pt has no reflexes------>so I go for D
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"Obstacles are those frightful things you see when you take your EYES off your goal."
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| nadiabarati
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D
hey Aashi, you are a great teacher. God bless you, dear.
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