A 34-year-old woman is brought to the emergency department due | Uworld | Step 2ck

A 34-year-old woman is brought to the emergency department due to a 2-day history of progressive dyspnea and drowsiness. According to her husband, she had difficulty swallowing food and almost choked while having dinner yesterday. One week ago, she was treated with ciprofloxacin for a urinary tract infection. The patient volunteers in a local library and for the past several months has had to reduce her work hours due to difficulty lifting books and placing them on shelves. She drinks alcohol socially and does not smoke. Her blood pressure is 142/90 mm Hg, pulse is 92/min, and respirations are 20/min and shallow. Pulse oximetry shows 93o/o on room air. The patient's BMI is 32 kgfm2. Her speech sounds nasal. Physical examination demonstrates clear lung fields with the use of accessory muscles of respiration and paradoxical abdominal wall motion with inspiration. Heart sounds are normal without a murmur. Muscle strength is bilaterally decreased with normal deep tendon reflexes . Babinski reflex is absent bilaterally. Arterial blood gas shows pH 7.2, pC02 65 mm Hg, and p02 90 mm Hg.