A 52-year-old woman comes to the physician because of a 3-month history of pain and a burning sensation in both feet. The symptoms worsen when she tries to fall asleep at night. She has hypertension, type 2 diabetes mellitus, and chronic knee pain. Current medications are enalapril, hydrochlorothiazide, metformin, sitagliptin, and tramadol. She does not smoke, drink alcohol, or use illicit drugs. She is 165 cm (5 ft 5 in) tall and weighs 77 kg (170 lb); BMI is 28 kg/m2. Her temperature is 36.8°C (98.2°F), pulse is 78/min, and blood pressure is 130/84 mm. On physical examination, ankle reflexes are absent and sensation of joint position is decreased in the toes. Romberg sign is present. A lesion involving which of the following best explains this patient's findings?

Question

A 52-year-old woman comes to the physician because of a 3-month history of pain and a burning sensation in both feet. The symptoms worsen when she tries to fall asleep at night. She has hypertension, type 2 diabetes mellitus, and chronic knee pain. Current medications are enalapril, hydrochlorothiazide, metformin, sitagliptin, and tramadol. She does not smoke, drink alcohol, or use illicit drugs. She is 165 cm (5 ft 5 in) tall and weighs 77 kg (170 lb); BMI is 28 kg/m2. Her temperature is 36.8°C (98.2°F), pulse is 78/min, and blood pressure is 130/84 mm. On physical examination, ankle reflexes are absent and sensation of joint position is decreased in the toes.  Romberg sign is present.  A lesion involving which of the following best explains this patient's findings?

Quizplus · Accepted Answer

Eductional Objective: Diabetes mellitus is the most common cause of peripheral polyneuropathy in adults.  Common findings include numbness and paresthesias in a stocking-glove distribution and decreased proprioception due to degeneration of large-fiber sensory axons.

A 52-Year-Old Woman Comes to the Physician Because of a 3-Month