08-01-2008, 09:39 AM
A 7-year-old white female is brought to your office because of a 3-day history of an increasingly clumsy gait. The mother noted that she first observed the problem 2 days earlier when her daughter climbed out of the bathtub and had difficulty standing up while being dried off. At the time she thought the child was just playing. The next day the child seemed better and went to school, but was sent home because she was having difficulty on the playground and said that "it was hard" going up the stairs. The child had a minor upper respiratory illness, as did other family members, but otherwise was not particularly sick. However, on the morning of this office visit, the child was unable to stand up when she got out of bed and had difficulty using her spoon to eat her cereal. She had no difficulty swallowing.
Examination is within normal limits, except for a slightly runny nose which drains clear, watery mucus. There is no evidence of ear infection or sinusitis. She has profound weakness (but not total paralysis) of the lower extremities, and to a lesser extent, the upper extremities. There is no sensory deficit and no difficulty with urination.
never having had any similar symptoms. The family lives in a rural area near woods; she has two older brothers. Family pets include two dogs, a cat, and a parakeet. No family members or animals are sick. Blood counts, chemistries, urinalysis, cerebrospinal fluid, a CT scan of the head, and a chest roentgenogram are all normal. A tick is found in her scalp.
Which one of the following statements is true concerning this patient's condition?
a. The most likely diagnosis is tick paralysis; the tick should be removed and the patient followed
b. Since the patient had progressive symptoms for 3 to 4 days, removing the tick at this point will probably not lead to total recovery
c. Tick paralysis is fatal to the majority of patients
d. The paralysis is caused by a toxin produced by Babesia microti
e. Treatment includes physical therapy and broad-spectrum antibiotics
Examination is within normal limits, except for a slightly runny nose which drains clear, watery mucus. There is no evidence of ear infection or sinusitis. She has profound weakness (but not total paralysis) of the lower extremities, and to a lesser extent, the upper extremities. There is no sensory deficit and no difficulty with urination.
never having had any similar symptoms. The family lives in a rural area near woods; she has two older brothers. Family pets include two dogs, a cat, and a parakeet. No family members or animals are sick. Blood counts, chemistries, urinalysis, cerebrospinal fluid, a CT scan of the head, and a chest roentgenogram are all normal. A tick is found in her scalp.
Which one of the following statements is true concerning this patient's condition?
a. The most likely diagnosis is tick paralysis; the tick should be removed and the patient followed
b. Since the patient had progressive symptoms for 3 to 4 days, removing the tick at this point will probably not lead to total recovery
c. Tick paralysis is fatal to the majority of patients
d. The paralysis is caused by a toxin produced by Babesia microti
e. Treatment includes physical therapy and broad-spectrum antibiotics