68 y/o male describes a 2 year history of insomnia that she attributes to an inability to get comfortable in bed due to a “creepy crawly” sensation in her lower limbs. Physical exam is normal.
Absent during the day
Also bothersome when she sits
Walking relieves the sensation
What is the most likely diagnosis? (1pt)
Which of the following studies should be done next? (1pt)
a) Serum ceruloplasmin
b) Serum ferritin level
c) Urine porphyrin level
d) Nerve conduction study
e) Magnetic resonance image of the brain
Riddler #6 Answer
Restless leg syndrome
May be a result of iron deficiency
Iron supplementation may resolve symptoms
Otherwise usually responds to dopamine agonist: pergolide, pramipexole, or ropinirole
A 40 y/o man has a 3 month history of dysphagia with solids. Symptoms occur twice a week, especially when he eats fast. Hard bread and tough meats are particularly bothersome. Denies heartburn or weight loss. Does not smoke or drink and takes no medications. Exam and Labs are nml.
Riddler #7, con’t
A barium swallow is shown
1pt) What’s the diagnosis
1pt) Whats the treatment?
Bonus: Will the Redskins win? (must be answered today) 3pt’s