A patient with a meningitis and facial weakness of unknown etiology had been given isoniazid and rifampin. There was no improvement and she is treated with high-dose steroids. Within 1 week of the introduction of prednisone, she develops pain radiating down the back of her right leg and has difficulty dorsiflexing the right foot. This new symptom most likely represents which of the following disorders?

a. Borrelia radiculopathy

b. Diabetic mononeuritis multiplex

c. Isoniazid neuropathy

d. Rifampin toxicity

e. Tuberculous radiculopathy

the answer is below…

The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.

The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.

This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.

The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.

All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.

Medical doctors with an M.D. degree are required to pass this examination before being permitted to practice medicine in the United States of America

The correct answer is a; Borrelia radiculopathy.[3]

This patient has, in effect, developed a noncompressive sciatica, or Lyme neuropathy. Dorsiflexion of the foot is controlled primarily by the anterior tibial muscle. The deep peroneal nerve supplies this muscle and arises from the common peroneal nerve just below the knee. A sciatic nerve injury may also produce foot-drop, and irritation of spinal roots to the sciatic nerve produces the foot-drop that may occur with Lyme radiculopathy. Lyme disease causes painful radiculopathies and peripheral neuropathies. Tuberculosis may cause similar symptoms, but steroid therapy is often useful in suppressing that complaint in chronic tuberculous meningitis. Steroid-induced diabetes mellitus would be unlikely to evolve to the point that a painful neuropathy developed over so short a time.