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(Created page with "{{WBRQuestion |QuestionAuthor=William J Gibson |ExamType=USMLE Step 2 CK |MainCategory=Internal medicine |SubCategory=Neurology, Neurology, Neurology |MainCategory=Internal me...") |
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|Prompt=A 58 year old woman presents to the hospital for bilateral lower extremity leg cramps, paresthesias, and lower extremity weakness (right greater than left). She reports the symptoms occurred gradually over the course of two days. On admission, she is found to have urinary retention and a foley catheter is inserted. On physical exam she is afebrile, and her mental status is normal. She has symmetric 2+ reflexes in the lower extremities. Proprioception and sensation to vibration are diminished bilaterally in the lower extremities. The patient reports a general feeling of numbness below the umbilicus. She is unable to stand or ambulate on her own. The results of T2 spinal MRI are shown below. A lumbar puncture is performed, which demonstrates total protein of 141 mg/dL, glucose of 80 mg/dL and 13 WBC/mL. | |Prompt=A 58 year old woman presents to the hospital for bilateral lower extremity leg cramps, paresthesias, and lower extremity weakness (right greater than left). She reports the symptoms occurred gradually over the course of two days. On admission, she is found to have urinary retention and a foley catheter is inserted. On physical exam she is afebrile, and her mental status is normal. She has symmetric 2+ reflexes in the lower extremities. Proprioception and sensation to vibration are diminished bilaterally in the lower extremities. The patient reports a general feeling of numbness below the umbilicus. She is unable to stand or ambulate on her own. The results of T2 spinal MRI are shown below. A lumbar puncture is performed, which demonstrates total protein of 141 mg/dL, glucose of 80 mg/dL and 13 WBC/mL. | ||
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<img src='https://upload.wikimedia.org/wikipedia/commons/thumb/d/de/Transverse_myelitis_MRI.jpg/550px-Transverse_myelitis_MRI.jpg'> | <img src='https://upload.wikimedia.org/wikipedia/commons/thumb/d/de/Transverse_myelitis_MRI.jpg/550px-Transverse_myelitis_MRI.jpg'> | ||
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|AnswerC=Tabes dorsalis | |AnswerC=Tabes dorsalis | ||
|AnswerD=Subactute combined degeneration | |AnswerD=Subactute combined degeneration | ||
|AnswerDExp=Subacute combined degeneration is caused by Vitamin B12 deficiency. | |||
|AnswerE=Cauda equina syndrome | |AnswerE=Cauda equina syndrome | ||
|Approved=No | |Approved=No | ||
}} | }} | ||
Revision as of 03:24, 11 February 2016
| Author | PageAuthor::William J Gibson |
|---|---|
| Exam Type | ExamType::USMLE Step 2 CK |
| Main Category | |
| Sub Category | SubCategory::Neurology |
| Prompt | [[Prompt::A 58 year old woman presents to the hospital for bilateral lower extremity leg cramps, paresthesias, and lower extremity weakness (right greater than left). She reports the symptoms occurred gradually over the course of two days. On admission, she is found to have urinary retention and a foley catheter is inserted. On physical exam she is afebrile, and her mental status is normal. She has symmetric 2+ reflexes in the lower extremities. Proprioception and sensation to vibration are diminished bilaterally in the lower extremities. The patient reports a general feeling of numbness below the umbilicus. She is unable to stand or ambulate on her own. The results of T2 spinal MRI are shown below. A lumbar puncture is performed, which demonstrates total protein of 141 mg/dL, glucose of 80 mg/dL and 13 WBC/mL.
What is the most likely diagnosis?]] |
| Answer A | AnswerA::Central cord syndrome |
| Answer A Explanation | [[AnswerAExp::Central cord syndrome is defined as injury to the central portion of the spinal cord. It is typically caused by hyperextension injuries in the cervical spine (eg whiplash). It typically causes weakness in a cape-like distribution along the upper extremities.]] |
| Answer B | AnswerB::Transverse myelitis |
| Answer B Explanation | AnswerBExp:: |
| Answer C | AnswerC::Tabes dorsalis |
| Answer C Explanation | AnswerCExp:: |
| Answer D | AnswerD::Subactute combined degeneration |
| Answer D Explanation | AnswerDExp::Subacute combined degeneration is caused by Vitamin B12 deficiency. |
| Answer E | AnswerE::Cauda equina syndrome |
| Answer E Explanation | AnswerEExp:: |
| Right Answer | RightAnswer:: |
| Explanation | [[Explanation::The patient in this vignette has transverse myelitis. She has symptoms of an upper motor neuron lesion (hyperreflexia) in both lower extremities. Her CNS insult is therefore either in the spine or the brain. Educational Objective: |
| Approved | Approved::No |
| Keyword | |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |
