A 61-year-old man, who smokes five packs of cigarettes per day and has hypertension, had an abdominal aortic aneurysm repair 8 hours ago. The surgery went very well, and there were no reported perioperative complications. Now the patient is unable to move his legs and states that they are “numb.” On examination, he has a flaccid paresis of both lower extremities and has impaired pinprick sensation to a T9 level bilaterally. Joint proprioception is normal. Which of the following is the most likely diagnosis in this case?
a. Cerebral stroke
b. Conversion disorder
c. Multiple sclerosis
d. Spinal cord compression
e. Spinal cord infarct
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.
The correct answer is e; Spinal cord infarct.
This patient probably has a spinal cord infarction from an anterior spinal artery occlusion. The posterior cord may be spared, preserving joint proprioception. Bilateral lower extremity deficits without cranial nerve or mental status findings would be an exceedingly unusual cerebral stroke presentation. There is no information, such as psychological stressors or a nonphysiologic exam, to suggest a conversion disorder in this case. Multiple sclerosis causes neurological deficits over space and time. In this case we have a single deficit at a single point in time. History of metastatic cancer or trauma might make the physician suspect spinal cord compression.