A 62-year-old woman presents with recurrent attacks of the room spinning around her in a horizontal plane, which is happening on multiple occasions every day. Each attack lasts about ten seconds and seems to occur whenever she turns in bed, lies down or sits up from the supine position. There are no other associated symptoms. She is taking no medication. Standard neurological examination is normal.
Given the likely diagnosis, which of the following is the most appropriate management?
A 68-year-old woman presents with a 2-day history of left earache, vertigo and loss of taste. There is left-sided weakness of both the upper and the lower facial muscles. Facial sensation is normal. There is a vesicular rash on the eardrum, ear canal, earlobe, tongue and roof of the mouth (palate) on the same side as the weakness of the face.
Select the single most likely diagnosis.
A 35-year-old woman visits her General Practitioner with complaints of persistent fatigue over the past six months. She used to be quite active and had no other medical issues, but now she is unable to maintain her previous exercise routine. It takes her several days to recover from fatigue after exercising. The doctor suspects a diagnosis of chronic fatigue syndrome (CFS).
What is the most likely additional feature that would support this diagnosis?
A 28-year-old woman, who works as a croupier and is typically in good health, woke up 3 weeks ago with weakness in her left hand. She experienced numbness at the base of the thumb on the dorsum of the hand. She takes the oral contraceptive pill. She drinks alcohol in binges, one of which occurred the night before her symptoms started, and smokes 15 cigarettes per day. She has a normal general examination, normal cranial nerves and normal muscle tone, but mild weakness of the left brachioradialis and moderate weakness of wrist and finger extension. She has full power in her other arm muscles, including elbow extension. Reflexes are normal.
What is the most likely lesion causing her symptoms?
A 29-year-old woman began to stumble when walking. Her right leg was slightly stiff and weak, especially after exercise and hot showers. These symptoms developed over 3 days and gradually disappeared over 4 weeks. She was on the college swimming team before these symptoms arose. There, she developed a unique and extreme type of fatigue that was different from the usual fatigue she experienced when swimming. This disappeared after several weeks, but reappeared again 6 months before her current presentation.
Select the single most likely diagnosis.
A 78-year-old man comes to the clinic with a change in his behaviour, his wife has also noticed a few aggressive outbursts over the past months. His mini-mental test score is 20.
Which patterns of cognitive deficit would favour a dementia of subcortical origin?
A 25-year-old man presents to you with concerns that he may be losing his mind. He reports experiencing peculiar odors (such as burnt rubber) and frequently feeling jamais vu. No one else detects any unusual smells during these episodes. He remains fully conscious and has excellent recall of the events. What is the probable diagnosis?
A 52-year-old man comes to his General Practitioner with a complaint of lower back pain that has been gradually worsening over six weeks. He reports a burning sensation that extends into his buttock and down his right leg, along with paraesthesia in the same region. He believes that his right leg is weaker.
What is the one characteristic that indicates a sciatic nerve lesion?
A 60-year-old woman complains of unpleasant sensations in the legs accompanied by an urge to move the legs. The sensations occur only at night when she is inactive and sometimes occur in bed making it difficult to get off to sleep. There are no abnormal signs on examination of the legs and she is otherwise in good health.
Select from the list the single most likely diagnosis.
A 25-year-old woman presents with headaches. She suffered headaches occasionally in her early twenties but has had them more frequently over the past 2 months.
Select from the list of options the single feature that would suggest a diagnosis of tension type headache rather than migraine.