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Thread: q - excellent

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    q - excellent

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    A 43-year-old man is evaluated in your office because of “numb” feet and “weak” ankles. These symptoms began approximately 3 to 4 years ago. His wife comments that she can hear him walking because of the “slapping noise” that he makes when taking steps. Furthermore, she states that the patient’s gait is similar to his father’s gait. The patient is not aware of any tingling or pain and by numbness he means a “dead sensation” in his feet. He has occasional low back pain without radiation into the legs and also has nocturnal cramps in his calves.

    On physical examination, he is afebrile. Pulse rate is 78/min, and blood pressure is 120/80 mm Hg. He has pes cavus and hammer toes bilaterally. There is atrophy of the distal lower extremity muscles, as well as slight atrophy of intrinsic hand muscles bilaterally. He cannot walk on his heels. There is moderate weakness of ankle dorsiflexor and toe extensor muscles and mild weakness of the interossei muscles in the hands. Deep tendon reflexes are hypoactive to absent throughout, and plantar responses are flexor bilaterally. Vibratory sensation is impaired in the feet bilaterally, and there is a stocking level of sensory loss to pinprick and light touch.

    Which of the following diagnostic studies should you order at this time?

    (A) MRI of the lumbosacral spine
    (B) Serum creatine kinase determination
    (C) Nerve conduction studies and electromyography
    (D) Skeletal muscle biopsy

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    ANS

    The answer is c.charcots marie tooth disease

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