A patient with Crohn's disease complains of extreme muscle weakness, fatigue, diarrhea, bruising, 10-pound weight loss over the last few weeks, and dypnea on exertion.
On physical examination, the patient is afebrile, pulse 110, resps 20/min, and BP 100/ 50. BMI is 15. The patient is pale and frail looking, with bilateral ankle edema and bruises noted on cachetic thighs. Which of the following diagnostic tests is most helpful in the diagnosis of intestinal malabsorption?
A. Liver enzymes
B. Vitamin B12 assay
C. Stool for fat
D. INR
Question 2A 23-year-old female complains of episodes of blurry vision and numbness and tingling in the left foot. When the foot falls asleep, the patient feels imbalanced and a gait disturbance develops, making the patient fall.
The patient has a medical-surgical history of appendectomy age 10. Otherwise, patient has no history of illness and takes no medications. Denies use of tobacco or alcohol. On physical examination, vital signs are T 98 degrees,18 resps/min, pulse 66, and BP 110/60. Vision: 20/20 os, 20/20 od, and 20/20 ou. Heart: regular rate and rhythm, no murmurs. Lungs are clear to auscultation. Abdomen is non-tender with no organomegaly. Extremities: Skin is pink, cool to touch, and intact bilaterally. Left and right quadriceps muscle strength 5/5. DTRs left and right + 2/4. No clonus. Negative Homan's and Babinski's sign. Sensation to pinprick and cotton ball intact in extremities and equal bilaterally. Dorsalis pedis pulses +1 /4 bilaterally. No neurological deficits. The following disorder(s) should be considered in the diagnosis:
A. Multiple sclerosis
B. Peripheral vascular disease
C. Restless leg syndrome
D. None of the above
Question 3When assessing a patient who complains of muscle weakness, the clinician should assess if there is specifically:
A. Bilateral or unilateral muscle weakness
B. Proximal versus distal muscle weakness
C. Upper extremity and/or lower extremity weakness
D. All of the above
Question 4A 66-year-old female complains of fatigue and a burning and itching feeling in the legs. Patient reports that the leg problem occurs during sleep and awakens her during the night.
Current medications include: ACE inhibitor, Wellbutrin, and Prilosec. Denies use of tobacco or alcohol. History of hypertension, GERD, and depression. On physical examination, vital signs are T 98 degrees, 18 resps/ min, pulse 66, and BP 110/60. Heart: regular rate and rhythm, no murmurs. Lungs are clear to auscultation. Abdomen is non-tender with no organomegaly. Extremities: Skin is pink, cool to touch, and intact bilaterally. + Hallux valgus bilaterally. Left and right quadriceps muscle strength 5/5. DTRs left and right + 3/4. No clonus. Negative Homan's and Babinski's sign. Sensation to pin prick and cotton ball intact in extremities and equal bilaterally. Dorsalis pedis pulses +1/4 bilaterally. No neurological deficits. These signs and symptoms are characteristic of:
A. Peripheral vascular disease
B. Restless leg syndrome
C. Peripheral neuropathy
D. All of the above
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