Step 2

Neurology 7

A 56-year-old woman presents to the emergency department complaining of progressive weakness for the past 3 weeks. Prior to the onset of her symptoms, she was able to ambulate without assistance, and she was fully independent with all her daily activities. Approximately 3 weeks ago, she noted some weakness in her arms and legs on both sides which has progressed to a point where she is having trouble walking up the stairs or lifting any heavy objects. She says it has been difficult for her to get herself up from a chair as well. She has been mostly sitting on her couch or bedbound in the past couple days. She says she has been taking lisinopril for hypertension and atorvastatin for hyperlipidemia for the past five months. On review of systems, she denies fever, recent travel, recent vaccination, sick contacts, chest pain, difficulty breathing, recent trauma or injury, or urinary and bowel incontinence. She denies alcohol or substance use. She works as a gardener. Physical examination shows bilateral weakness in her proximal arms and legs with 3/5 strength in the affected areas. Her brachial and patellar reflexes are 2+. Distal pulses are 2+. Laboratory findings show elevated creatine kinase of 2300 IU/L. TSH is within normal limits.

Considering the most likely diagnosis, which of the following is the most appropriate next step in management?

  • A) Consult Neurology
  • B) Discontinue atorvastatin
  • C) Obtain anti–acetylcholine receptor antibody
  • D) Obtain anti-HMG-CoA reductase autoantibody
  • E) Obtain CT of the head

Authors

Yunjia Shen

Editor

Dr. Raj Dasgupta

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