Question

a man staggers into the clinic. he is known to be a heavy cocaine and alcohol user. part of the clinical data gathered includes a urine sample, which is very dark in color. he complains of weakness and has a \small\ seizure in the exam room. the practitioner suspects that he may have _______

multiple choice

fibromyalgia

trichinosis

tetanus

rhabdomyolysis

botulism

Explanation:

Analyze clinical presentation

The patient is a heavy cocaine and alcohol user presenting with weakness, a history of a "small" seizure, and very dark urine. Cocaine use, excessive alcohol consumption, and seizures are classic triggers for severe muscle breakdown.

Connect symptoms to pathology

When skeletal muscle tissue breaks down rapidly, it releases intracellular contents into the bloodstream, including myoglobin. The kidneys filter this myoglobin, which causes the urine to become very dark (often described as tea-colored or cola-colored). This condition of muscle necrosis is known as rhabdomyolysis.

Evaluate the options

• fibromyalgia: Characterized by widespread chronic musculoskeletal pain, fatigue, and localized tenderness, but does not cause dark urine or acute muscle breakdown.
• trichinosis: A parasitic infection caused by eating undercooked meat, presenting with diarrhea, fever, and muscle pain, but not typically acute dark urine following drug/alcohol use and seizures.
• tetanus: A bacterial infection causing painful muscle spasms (lockjaw), not directly associated with dark urine or drug-induced acute muscle necrosis.
• rhabdomyolysis: Directly matches the triad of muscle weakness, dark urine (myoglobinuria), and precipitating factors (cocaine, alcohol, and seizure activity).
• botulism: A rare poisoning causing flaccid paralysis, not associated with dark urine or muscle breakdown.

Answer:

• fibromyalgia
• trichinosis
• tetanus
• rhabdomyolysis (Correct answer)
• botulism