Items 648 through 649

A 72-year-old man complained of pain about the waist at the level of the umbilicus. The pain was often burning and occasionally shooting. It did not extend down his legs, but he did notice some weakness in his legs at the time of the pain. With exertion, such as walking, he developed pain in his legs and a tingling sensation in his feet. He took aspirin for the discomfort, but noticed no substantial change in the sensation. Roentgenograms of his spine revealed no abnormalities. Pain and weakness became increasingly frequent over the course of several months. Because he complained of urinary hesitancy and frequency in association with an enlarged prostate, he was advised to have a transurethral prostatectomy. A general anesthetic was given for the surgery. On recovering consciousness postoperatively, the patient cannot move his legs and has persistent pain at the level of the umbilicus. His plantar responses are bilaterally extensor.

6-48. The most appropriate emergency evaluation for this patient is a. A voiding cystometrogram b. An electroencephalogram (EEG)

c. Somatosensory evoked potentials (SSEPs)

d. An aortogram e. A penile-brachial index (PBI)

6-49. The patient has a greatly dilated abdominal aorta with a normal thoracic aorta. The most likely cause of this damage is a. Syphilis b. Trauma c. Chronic hypertension d. Diabetes mellitus e. Atherosclerosis

6-50. About 12 days after a mild upper respiratory infection, a 12-year-old boy complains of weakness in his lower extremities. Over several days, the weakness progresses to include his trunk. On physical examination, he has the weakness described and no lower extremity deep tendon reflexes, muscle atrophy, or pain. Spinal fluid studies are notable for elevated protein only. The most likely diagnosis in this patient is a. Bell's palsy b. Muscular dystrophy c. Guillain-Barre syndrome d. Charcot-Marie-Tooth disease e. Werdnig-Hoffmann disease

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