Approach to differentiating lesions (neuromuscular junction) Quiz: Ace Your Exams
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A 52-year-old farmer presents to the emergency department for evaluation of weakness. He has noticed difficulty chewing, swallowing, and lifting equipment for the past two days. He endorses dry eyes, dry mouth, and constipation. Today, he developed shortness of breath. Past medical history is noncontributory, and he takes no medications. His temperature is 37.0°C (98.6°F), pulse is 80/min, respirations are 12/min, and blood pressure is 128/82 mmHg. On exam, he appears alert with bilateral ptosis, hypophonic and dysarthric speech, nasal flaring, and weakness with bilateral shoulder abduction. Lower extremity strength and sensation appear normal throughout. Which of the following details is most important to obtain next?
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