A 34-year-old woman comes lo the emergency department due to sudden onset of tingling and numbness


A 34-year-old woman comes lo the emergency department due to sudden onset of tingling and numbness in her left hand She is an assistant chef al a nearby restaurant and was lifting a box earlier in the day when she heard a “pop” and her left hand went numb.The patient’s numbness is in a glove distribution Her fingers, entire left hand, and wrist are numb, with normal sensation above her wrist. The patient describes her numbness as feeling like “pins and needles.” Medical history is insignificant The patient allows the nurse to take her vital signs but refuses any further physical examination, insisting that ii will worsen her discomfort. Temperature is 37.2C (99 F), blood pressure is 120170 mm Hg, pulse is 72/min, and respirations are 16/min. The patient asks for a doctor’s note to excuse her from work, fearing that her condition will worsen if she does not take some lime off to heal. Which of the following is the most likely diagnosis?

  • A Conversiondisorder
  • B Factilious disorder
  • C Malingering
  • D Mononeuropathy
  • E Polyneuropathy
  • F Radiculopathy

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29-year-old woman at 25 weeks gestation comes to clinic for routine prenatal care. She has a history of chronic hepatitis C infection

acquired approximately 10 years ago. Her pregnancy has been otherwise uncomplicated to date. She is married and is monogamous

with her husband, who is aware of her hepatitis infection. Her past medical history is significant only for an appendectomy at age 12.

She has not been immunized against hepatitis A or B. She takes no medications, aside from a daily prenatal multivitamin. Which of

the following recommendations should be given to this patient?

  • Q A Avoid breastfeeding the baby
  • Q B. Begin treatment with interferon-a and ribavirin
  • Q C. Obtain hepatitis A and B vaccinations now
  • Q D. Schedule an elective cesarean delivery
  • Q E. Use barrier protection for all sexual intercourse

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4-year-old boy is brought to the pediatrician

for evaluation of frequent falls. His mother says

that for the past 6 months he seems to be moving

more slowly than usual, and he can’t run as

quickly and can’t climb stairs. The boy was

born at 39 weeks’ gestation via normal spontaneous

vaginal delivery with no complications.

He has been otherwise healthy and achieved

all of his appropriate motor and speech milestones.

Family history is signifi cant for a maternal

uncle who died at age 20 years from respiratory

failure. On physical examination the

patient has hyperlordosis of the spine. His

calves are very prominent bilaterally. When

asked to lie on his back and stand up, he fi rst

rolls over onto his stomach and then uses his

hands to climb up his legs until he is standing.

He has 3/5 strength in his shoulders and thighs

bilaterally, but 5/5 strength in his hands, calves,

and feet. The rest of the neurologic examination

is unremarkable. Serum creatine kinase

level is 1500 U/L. How was this boy’s disorder

most likely inherited?

  • (A) Autosomal dominant
  • (B) Autosomal recessive
  • © Autosomal trisomy
  • (D) Mitochondrial
  • (E) X-linked recessive

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