Questions 363 to 364
363.A 46-year-old woman presents to the ED with left-sided arm and leg
weakness for half an hour. She has no medical problems except for chronic
neck pain after a motor vehicle collision 5 years ago. On examination she
has right eye miosis, partial ptosis, and 3/5 strength in her left upper and
lower extremities. Which of the following is consistent with the patient’s
ocular findings?
a. Oculomotor nerve palsy
b. Bell palsy
c. Horner syndrome
d. Kehr sign
e. Nikolsky sign
364.On further questioning, the patient above states that earlier in the
day she saw a chiropractor for her neck pain. After the session she developed
severe right-sided neck pain. About an hour later she noticed difficulty
using her left side of her body. Which of the following is the most likely
diagnosis?
a. Internal carotid artery dissection
b. Cavernous sinus syndrome
c. Multiple sclerosis
d. Transverse myelitis
e. Spinous process fracture of a cervical vertebra
365.A 64-year-old man presents to the ED complaining of an episode of
vertigo he experienced while exercising in the gym today. He states that he
has been having similar episodes with exercise for a week. His routine consists
of running on a treadmill, lifting weights, and doing leg presses. The vertigo
usually occurs mid-routine when he is lifting weights and resolves with
cessation of exercise. He also noticed unusual left arm pain during these
episodes. He has hypertension for which he takes antihypertensive medication
and had a myocardial infarction 6 years ago. He decreased his smoking
from one pack per day to five cigarettes per day over the last 6 years. His
BP in the right arm is 148/80 mm Hg and in the left arm it is 129/74 mm Hg.
Which of the following is the most likely diagnosis?
a. Superior vena cava syndrome
b. Aortic dissection
c. Subclavian steal syndrome
d. Angina pectoris
e. Vestibular neuronitis
382 Emergency Medicine