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A 61-year-old man with a history of hypertension has been in excellent health until he presents with vertigo and unsteadiness lasting for 2 days. He then develops nausea, vomiting, dysphagia, hoarseness, ataxia, left facial pain, and right-sided sensory loss. There is no weakness. On examination, he is alert, with a normal mental status. He vomits with head movement. There is skew deviation of the eyes, left ptosis, clumsiness of the left arm, and titu-bation. He has loss of pin and temperature...

Answers

The answer is b. (Victor, pp 768-770.) The clinical scenario presented is most consistent with a neuropathy of Lyme disease, the infection caused by Borrelia burgdorferi. This spirochetal infection is tick-borne and is endemic in the area where this patient lives. The rash on his leg was most likely erythema chronicum migrans, a target-shaped lesion that enlarges as the central area returns to normal. His complaints and examination suggest a chronic meningitis preceded by an arthralgia, a...

Questions

DIRECTIONS Each item below contains a question or incomplete statement followed by suggested responses. Select the one best response to each question. 286. In Hirschsprung's disease, neural crest cells fail to migrate normally early in fetal development and produce potentially fatal complications within months of birth because of disturbed 287. A newborn infant has a cystic swelling at the base of the spine that is covered with hyperpigmented skin and some coarse hair. Which of the following is...

Items

A 62-year-old right-handed man has involuntary twitches of his left hand. He first noticed between 6 months and 1 year ago that when he is at rest, his left hand shakes. He can stop the shaking by looking at his hand and concentrating. The shaking does not impair his activities in any way. He has no trouble holding a glass of water. There is no tremor in his right hand and the lower extremities are not affected. He has had no trouble walking. There have been no behavioral or language changes....