Weakness and Dizziness 383366.A 36-year-old woman presents to the ED complaining of worsening
weakness over the past few weeks. She states that initially she attributed it
to being overworked but for the last few days she has been having unusual
difficulty getting out of chair or walking the steps to her fourth-floor apartment.
She has no prior medical history and takes no medications. Her vital signs
are unremarkable. On examination she has 5/5 strength in her bilateral
upper and lower extremities distally but 3/5 strength proximally. Sensory
examination and reflexes are normal. You also notice a red confluent macular
rash on her eyelids. Which of the following is the most likely diagnosis?
a. Myasthenia gravis
b. Multiple sclerosis
c. Dermatomyositis
d. Rhabdomyolysis
e. Disseminated gonococcal infection
367.A 32-year-old woman presents to the ED complaining of sudden onset
of left facial weakness that began half an hour ago that was noticed by her
coworker. She denies having medical problems or taking medications. On
the review of systems she admits to subjective fevers, fatigue, and arthralgias
for the last week, which she attributed to the flu. She also reports having a
rash on the back of her thigh a month ago, around the time she was hiking
in Rhode Island. On examination she has left facial paralysis. Which of the
following is the most likely diagnosis?
a. Bell’s palsy
b. Lyme disease
c. Ramsay Hunt syndrome
d. Brain tumor
e. Rocky Mountain spotted fever (RMSF)