11-20-2006, 06:41 PM
A 51 year old man comes to the clinic complaining of the inability to perform his daily activities because of weakness and fatigability in his extremities, especially his legs, for the past three weeks. He also has a cough productive of blood-tinged sputum for the last two months. His other past medical history is unremarkable. He has smoked one pack of cigarettes a day for over thirty years. He has lost about 20 pounds over the last month.Physical exam reveals: temperature 98.7 F, blood pressure 140/80 mm Hg, heart rate 88/min, and respiratory rate 16/min. Lungs are clear to auscultation. On neurologic exam, the cranial nerves are intact. Muscle strength in the extraocular muscles is intact. Muscular strength in the extremities is decreased to 4/5, and the weakness is more pronounced in the proximal muscle groups. His strength increases after several minutes of repetitive exercise. A chest x-ray reveals a 2-cm lesion in the left upper lobe with hilar and mediastinal lymph-node enlargement. The initial complete blood count and chemistry panel are unremarkable. Tensilon (edrophonium) test is of questionable effect. An EMG is ordered, and the anti-acetylcholine receptor antibody level is pending. What will be the most effective treatment of this patient's neurologic condition?
A. Pyridostigmine
B. Thymectomy
C. Prednisone
D. Plasmapheresis
E. Chemotherapy and radiation
A. Pyridostigmine
B. Thymectomy
C. Prednisone
D. Plasmapheresis
E. Chemotherapy and radiation