12-year-old boy is brought to the emergency department by his parents

12-year-old boy is brought to the emergency department by his parents as “he cannot walk anymore” The patient has had a pinsand-

needles sensation and weakness in both feet for the past few days This morning, he could not stand or move his legs and has

bilateral thigh pain. Two weeks ago, the patient had a febrile diarrheal illness that resolved on its own. He has had no headaches,

nausea, vomiting, or recurrent diarrhea. He and his family are vegetarians, and they recently visited a petting zoo. The patient has no

significant past medical history, and vaccinations are up to date. On arrival, temperature is 36.7 C (98 1 F), blood pressure is 150/90

mm Hg, pulse is 92/min, and respirations are 16/min; pulse oximetry is 99% on room air. Physical examination shows symmetric

flaccid paralysis of the lower extremities and absent ankle and patellar deep tendon reflexes. Sensation is intact to light touch in both

legs The upper extremities are weak and hyporeflexic. There is no photophobia or nuchal rigidity Which of the following structures

is primarily impaired in this patient’s condition?

  • QA Anterior horn cells
  • 0 B. Dorsal and lateral spinal columns
  • 0 C. Muscle fibers
  • 0 D. Neuromuscular junction
  • 0 E. Peripheral nerve fibers

0 voters

64-year-old man is brought to the emergency department due to sudden onset of painless lower-extremity weakness. He was

swimming in a pool and suddenly felt his legs become weak. He then felt that his legs had lost all strength, and he was unable to

move them. The patient struggled out of the pool, called emergency medical services, and was rushed to the hospital. He has no

trauma, loss of consciousness, or visual or speech problems. He cannot pass urine. Past medical history is significant for type 2

diabetes mellitus, hypertension, osteoarthritis, and long-standing back pain Physical examination shows significant motor weakness

in both legs and numbness from the umbilicus to the soles of the feet He has no sensation in the perinea! area. Rectal tone is

absent A Foley catheter is placed, and 800 ml of urine is collected. Which of the following is the best next step in management of

th is patient?

  • 0 A Complete bed rest for 24 hours
  • Q B. CT scan of the head without contrast
  • 0 C. Nerve conduction studies
  • Q D. Physiotherapy and nonsteroidal anti-inflammatory drugs
  • 0 E. Surgical evaluation

0 voters