Your 66-year-old male patient has recently started treatment for ...

[wenmo]

Your 66-year-old male patient has recently started treatment for metabolic syndrome and is currently taking the following medications: an ACE inhibitor and beta blocker for treatment of hypertension.
 
  He is also taking a statin medication, simvastatin for hyperlipidemia, and a biguanide, metformin, for type 2 diabetes. The patient complains of myalgias of the legs bilaterally and blood work shows elevated serum creatine kinase. Which of the medications can cause such a side effect?
  A. Beta blocker
  B. ACE inhibitor
  C. Statin medication
  D. Metformin

Question 2

A 56-year-old male presents with complaints of right-sided neck pain with radiation down the right arm into the right index finger and thumb. He reports a recent fall from a scaffold while painting on the job.
 
  On physical examination, you note a 0/4 biceps reflex on the right compared to 2/4 on the left and 1/5 grip strength of the right hand compared to 5/5 of the left hand. Which of the following is a test that can be performed to assist in the diagnosis of cervical disk herniation?
  A. Spurling's sign
  B. Apley's sign
  C. Lhermitte's sign
  D. A and C

[srodz]

Answer to Question 1

ANS: C
Myalgias are a side effect of lipid-lowering medications called statins. If the myalgia is related to rhabdomyolysis, the urine is often reddish-brown. When drug-induced myalgia is present, there is often eosinophilia. For rhabdomyolysis myalgia, the serum creatine kinase is significantly elevated.

Answer to Question 2

ANS: D
In cervical spine trauma, cervical disk herniation can occur. A positive Spurling's sign is noted if this maneuver reproduces neck and radicular pain, suggesting a herniated disk. Spurling's sign is tested for by lightly pressing downward on the top of the patient's head while tilting back and toward the side of pain. Lhermitte's sign may support suspicion of a herniated disk. This test is conducted by having the patient flex the neck in a chin-to-chest motion and is positive if an electric shock-like sensation down the spine results.