Review Question - QID 108955

A 68-year-old gentleman presents to the emergency department for decreased responsiveness. The patient was a successful businessman who managed a multi-billion dollar corporation until several months ago when he retired. Since then, he has had trouble taking care of himself as well as being reclusive and depressed. The patient's wife states that he no longer engages in any activities he once enjoyed and spends most nights awake, staring at the ceiling in tears. The patient has trouble getting out of bed and feels that his limbs are heavy and difficult to manipulate for everyday tasks. He has also been complaining of a numb and tingling sensation in his extremities for the past week. The patient no longer interacts with his wife and does not join her for meals or vacations. Since retirement, he typically stays in his room drinking yam-flavored schnapps all day. The patient does not have a significant past medical history. On physical exam, you see a confused gentleman who responds occasionally to your questions. He has a cough that recently started. He is poorly kempt, unshaven, and wearing a bathrobe. He does not cooperate with a neurological exam. On physical exam you note the findings in Figure A. The patient's skin is dry and unwashed. A chest radiograph is obtained and seen in Figure B. Lab values are below.
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