A 26-year-old male patient complains of abrupt onset of pain on the right side of his neck, accompanied by pain behind his right eye. After 12 hours, he experiences right ptosis and miosis of his right pupil, along with left-sided weakness and facial drooping. What could be the probable cause of his stroke?
A 28-year-old male patient complains of nasal congestion for the past six months. An ENT specialist previously diagnosed him with sinusitis. However, he returns with a new symptom of right periorbital swelling and double vision that started two days ago. Upon examination, the patient appears unwell with a temperature of 37.4°C. Although he does not have neck stiffness or photophobia, his right eyelid droops significantly, and his right eye is congested and deviated to the right with an enlarged pupil. The left eye appears normal, and fundoscopy shows no abnormalities. Additionally, the patient experiences a loss of sensation in the right forehead. What is the most likely diagnosis?
A 50-year-old man presents with diplopia, dysarthria, and difficulty swallowing. Over the next few days, he develops weakness in his upper and lower limbs, and by day four, he is unable to walk unaided. He denies any sensory symptoms or bladder disturbances and has no significant medical history. He is a non-smoker, does not drink alcohol excessively, and does not take any drugs. On examination, he has bilateral dilated and fixed pupils, binocular diplopia, and weak cough. His vital capacity is reduced, and he has lower motor neurone tetraparesis. He is hyporeflexic with normal sensation. Investigations, including blood tests, CT scan, nerve conduction studies, and EMG, are normal. What is the most likely diagnosis?
A 68-year-old man with a history of angina presents with worsening difficulty in walking throughout the day. He denies back or leg pain and has not experienced any trauma. After 4 hours in the Emergency Department, his condition worsens and he is now unable to stand and complains of urinary retention. On examination, he exhibits flaccid paralysis with hyperaesthesia in the T12 dermatome and reduced sensation below this point, while vibration sensation and proprioception remain intact. A palpable bladder is also noted. What is the most likely diagnosis?
A 50-year-old woman presents to the Medical Admission Unit with a 12-hour history of weakness. Two days prior to admission, she experienced double vision and increased unsteadiness while walking. On examination, a mass is found in her abdomen and she has reduced muscle tone and power, absent reflexes, and an ataxia. Initial investigations reveal normal blood counts, electrolytes, and liver function tests, but an elevated CRP. A CT brain scan is normal. What is the most useful investigation to reach a diagnosis?
A 45-year-old man is brought to the attention of the duty psychiatrist after being apprehended by the police for a violent assault outside a pub. He is extremely confused and agitated, repeatedly claiming that his wife is having an affair with the Prime Minister due to a message he believes is encoded in the traffic lights. He also reports not having slept in the last two days.
During the assessment, he experiences a tonic-clonic seizure that self-terminates in 3 minutes. He is taken to the Accident and Emergency department and reviewed by the medical team.
The medical SHO contacts his wife, who reports that he is normally healthy and last saw him when he left for work five days ago. At that time, he appeared normal but complained of a headache and took some ibuprofen.
During the clerking, he exhibits repetitive chewing movements of the mouth. Another tonic-clonic seizure occurs, which does not terminate after 10mg of intravenous diazepam. After 15 minutes, he is loaded with phenytoin. He continues to fit, requiring intubation and transfer to the Intensive Care Unit. Termination of seizure activity is only achieved after induction of general anaesthesia with thiopentone.
What is the most likely diagnosis?
You are summoned to a general medical ward during the night to assess a 49 year old female who has suddenly become agitated and disoriented. She was admitted to the hospital two days ago with a suspected urinary tract infection and has been recovering without incident. The patient has a medical history of a traumatic spinal injury at level C5 that occurred three years ago, resulting in spastic quadriparesis. Upon your arrival, her blood pressure is 220/105 mmHg, heart rate is 55/min, and she appears flushed and sweaty.
What additional symptom might you anticipate observing?
A 48-year-old woman presents to the emergency department with symptoms of flushing, diaphoresis, and agitation. She has a medical history of a spinal cord injury and is currently taking laxatives, codeine, and paracetamol. On examination, she has a bounding pulse, high blood pressure, and a rounded supra-pubic mass. Initial investigations reveal no significant abnormalities. What would be the most appropriate next step in managing this patient’s likely diagnosis?
A 45-year-old woman with myasthenia gravis is admitted to the hospital due to pneumonia and a flare-up of her myasthenia symptoms. She is given antibiotics, pyridostigmine, and methylprednisolone, and her condition begins to improve. Additionally, she receives IV magnesium replacement to address hypomagnesemia. However, the following day, her symptoms suddenly worsen, and she experiences significant weakness upon exertion and new dysphagia, necessitating the insertion of a nasogastric (NG) tube. Which medication administered by the medical team is the most likely culprit?
A 32 year-old male patient complains of gradual onset weakness in his right hand for the past week. Being right hand dominant, he is finding it difficult to perform simple tasks like unlocking a door with a key.
Upon examination, he displays significant weakness in flexing his thumb at the interphalangeal joint and flexion of the index and middle finger. No sensory deficit is detected.
What is the probable diagnosis?