A 67-year-old man who has smoked heavily for 45 years describes that with exertion, such as walking, he develops pain in his legs and a tingling sensation in his feet. X-rays of his spine reveal no abnormalities. Pain and weakness have become increasingly frequent over the course of several months. The pain and weakness described by the patient with exertion is probably a manifestation of which of the following?

a. Myotonia

b. Myokymia

c. Spinal claudication

d. Spondylolisthesis

e. Spondylolysis

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 c; Spinal claudication

With exertion, blood that would be available to the spinal cord under resting conditions might be shunted to the more patent blood vessels of the limb muscles. Unlike more typical claudication, in which leg pains develop because of poor blood flow to leg muscles, the leg pains of spinal claudication develop because of shunting of blood to the leg muscles. The pain is a reflection of ischemia to the sensory neurons in the spinal cord. Spondylolisthesis (the slippage of vertebral elements) and spondylolysis (the idiopathic dissolution of vertebral elements) may lead to pain with exertion because of the vertebral instability associated with these commonly linked conditions. However, these diagnoses should be apparent on x-rays. Myotonia and myokymia are disturbances of muscle activity that would not be expected in association with ischemic spinal cord disease.