A 10-Year-Old Boy Is Brought to the Pediatric Clinic Due

A 10-year-old boy is brought to the pediatric clinic due to unusual classroom behavior for the past year, which has worsened over the last few weeks.  Although the patient is generally quiet, he intermittently disrupts the class with sniffling, repetitive throat clearing, and grunting sounds.  His teacher states that the boy distracts other students and that his focus in class is poor.  The behaviors worsen when he is tired, stressed, or excited.  The patient's parents are also concerned because he has only a few friends and his classmates make fun of him.  Medical history is significant for recurrent otitis media as a toddler, atopic dermatitis, and an influenza infection 9 months ago.  Family history is significant for rheumatoid arthritis and anxiety in his mother.  Temperature is 36.7 C (98 F) , pulse is 78/min, blood pressure is 110/72 mm Hg, and respirations are 14/min.  Physical examination shows frequent eye blinking and shoulder shrugging but is otherwise normal.  Which of the following is the most likely diagnosis?

A) Attention-deficit hyperactivity disorder
B) Stereotypic movement disorder
C) Sydenham chorea
D) Tourette syndrome
E) Wilson disease

Correct Answer:

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