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 BOF 57

 

   

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BOF: 57

A 40-year-old female presents with a history of difficulty in walking. There was no significant past medical history and she was not taking any medications. She smoked 20 cigarettes a day and had done so for 20 years. She consumed 12 units of alcohol a week.

On examination there was no muscle wasting, she was noted to have increased tone in her lower limbs, power was decreased in both lower limbs, reflexes were exaggerated and plantars were upgoing.

There was no sensory deficit. Neurological examination of the cranial nerves, upper limbs and abdomen was normal.

Investigations

Hb 12. 6 g/dL

WBC 7.5 x 109 /L

Platelets 350

ESR 14 mm in 1st hour

Sodium 138 mmol/L

Potassium 4.3 mmol /L

Urea 4.4 mmol/L

Corrected calcium 2.9 mmol/L

Chest X-ray showed bilateral hilar lymphadenopathy

In this patient which one of the following would you arrange next ?

a)      Mediastinoscopy and lymph node biopsy

b)      Endoscopic ultrasound and lymph node biopsy

c)      Bronchoscopy

d)      Serum ACE

e)      MRI brain and spinal cord

 

 

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