nb1:q14 - kylie

[ArchivalUser]

A 67 yr old man comes to the physician bcz of 6 month history of double vision ,slurred speech and difficulty swallowing liquids.Initially these symptoms were intermittent but now occur everyday and are worse at the end of the day.Over the past week,he has had shortness of breath with exertion.He has pernicious anemia treated with monthly vitamin B 12 injections and autoimmune thyroid disease currently treated with thyroid replacement therapy.Examination shows BL ptosis and disconjugate gaze.There is bilateral facial weakness and hypernasal speecj.The tongue is weak and gag reflex is reduced.Muscle strength is 4/5 in the proximal muscles of the upper and lower extremities.Deep tendon reflexes are 2+ diffusely.Babinsky sign is absent.Sensory examination show no abnormality.A ct scan of the chest is shown.which of the following is the most likely diagnosis of this pt;s intrathoracic lesion?
a.aspiration pneumonia
b.bronchogenic Ca
c.lung metastasis
d.sarcoidosis
e.thymoma
f.thyroid Ca

[ArchivalUser]

The CT given is exactly like the one given here if u scroll down,the right image.A mass in the anterior mediastinum..Mhy answer is obviously thymoma..

[ArchivalUser]

http://emedicine.com/OPH/topic263.htm

[ArchivalUser]

this is tough for sure !
pt has got multiple CN palsies so what ? is that a feature of thymoma ?

[ArchivalUser]

the pt has
1.different autoimmune diseases like pernicious anemia,autoimmune thyroiditis.
2.BL ptosis,diplopia
3.different motor weaknesses like facial mucsle weakness,tongue weakness
4.symptoms are worse at the end of the day
5.difficulty breathing and swallowing
all these features point towards myasthenia and oneof the causes of myasthenia which itself is autoimmune disease is thymoma.what do u think?

[ArchivalUser]

I agree, it is thymoma.

[ArchivalUser]

agree, thymoma