A 73-year-old man presents to the oncology team with progressive lower thoracic back pain over the past three weeks. The pain has now reached an intensity that has prevented him from sleeping during the past two nights, despite over the counter analgesics. What investigations are appropriate for his back pain?
A 30-year-old woman visits her GP with complaints of difficulty climbing stairs at home. She mentions that her mother passed away in her early 50s due to severe pneumonia, and had trouble breathing and had to sleep propped up for several months before her death. The patient reveals that her parents were first cousins. She also reports struggling with exercise and sports during her school years and currently has a sedentary job in an office.
During the examination, the GP observes proximal weakness in her legs with lower motor neurone signs. There is mild upper limb weakness, but it is not as severe as in the lower limbs.
What is the most probable diagnosis?
A 57-year-old woman presented to the hospital with symptoms of sweating, nausea, palpitations, and intermittent crawling sensations in her hands and feet spreading up her arms and legs. She had recently visited her GP due to severe nausea and vomiting, and as a result, her GP had stopped all her medications. The patient had a medical history of hyperthyroidism, anxiety, depression, and atrial fibrillation, for which she was taking carbimazole, propranolol, paroxetine, amiodarone, and aspirin. Within two days of stopping her medications, she developed the aforementioned symptoms, along with anxiety, erratic behavior, and vivid dreams. On examination, her blood pressure was 140/78 mmHg, pulse was 97/min and irregularly irregular, and neurological examination revealed poor attention and concentration. Investigations showed abnormal levels of haemoglobin, white cell count, and serum potassium. Based on this information, which medication withdrawal is likely responsible for the patient’s symptoms?
A 48-year-old woman presented to the general medical clinic with a complaint of progressive diffuse myalgia and weakness that had been ongoing for three months. She reported experiencing difficulty walking up and down stairs due to weakness in her shoulder muscles and thighs. Her medical history included hypertension and hyperlipidemia, for which she took atenolol and simvastatin regularly. On examination, there were no abnormalities in the cranial nerves or detectable neck weakness. However, there was general myalgia in the upper limbs and proximal weakness of 3/5 with preserved distal power. A similar pattern of weakness was observed in the lower limbs with preserved tone, reflexes, and sensation.
The following investigations were conducted: haemoglobin, white cell count, platelets, ESR (Westergren), serum sodium, serum potassium, serum urea, serum creatinine, plasma lactate, serum creatine kinase, fasting plasma glucose, serum cholesterol, plasma TSH, plasma T4, and plasma T3. Urinalysis was normal.
Based on these findings, what is the likely diagnosis?
A 25 year-old individual with epilepsy is admitted to the hospital with generalised tonic-clonic status epilepticus. The patient is currently on phenytoin. Despite receiving intravenous diazepam and phenobarbital, the seizures continue after 30 minutes.
What would be the most appropriate next step in managing this patient’s condition?
A 35-year-old Nigerian woman was referred for evaluation of progressive weakness and tingling in her lower limbs over the past 5 months. She has also noticed a decline in her vision and difficulty hearing the television. She is currently unemployed and struggling financially.
During examination, she had excoriations around the mucocutaneous junction of her mouth. Fundus examination revealed pale optic discs on both sides. Rinne’s test showed air conduction to be better than bone conduction. Audiogram revealed that she could hear 8000 Hz at 60 decibels and 250 Hz at 20 decibels.
The distal groups of muscles in all limbs were weak with 4/5 power, and tendon reflexes were reduced. Romberg’s test was positive.
What is the most likely diagnosis?
A 78-year-old male was brought into hospital after waking with left arm weakness predominantly affecting the hand with a left sided facial droop in an upper motor neuron pattern. His blood pressure on admission was 170/85 mmHg and his heart rate was 75 beats per minute and in sinus rhythm. His blood glucose level on admission was 7.5 mmol/L.
His initial CT brain showed some mild bi-temporal atrophic change and some chronic small vessel ischaemia without any acute ischaemic changes and in particular, no haemorrhage.
He was admitted with a suspected diagnosis of minor ischaemic stroke. Which of the following imaging modalities will confirm the diagnosis?
A 50-year-old man presents to his GP with sudden onset left-sided blurred vision and a history of bumping into things on his left side, leading to falls. He denies any pain in the left eye or associated headache and reports no weakness or sensory disturbance in his arms or legs. He has no known medical conditions but is being investigated for an isolated seizure and memory difficulties. He is a non-smoker and works on a cattle farm.
On examination, the patient has yellowish papules on the neck, and his blood pressure is 140/80 mmHg with a regular pulse of 72 beats per minute. Corrected visual acuity is 6/9 in the left eye and 6/6 in the right, with a left relative afferent pupillary defect. Fundoscopy reveals some pallor of the left optic disc and angioid streaks, and visual field testing shows a left homonymous hemianopia. The rest of the cranial nerve examination and peripheral nervous system examination are normal.
Investigations reveal normal electrolytes, urea, creatinine, glucose, and cholesterol levels, with an erythrocyte sedimentation rate of 15 mm. A transthoracic echocardiogram is normal. An MRI brain and orbits (FLAIR) show multiple bilateral ischemic infarcts in the brain and a large right parieto-occipital infarct, with normal orbits and optic nerves.
What is the most likely diagnosis?
A 50-year-old male presents with a 4-week history of speech slurring, dysphagia and droopiness of his eyelids. He has a past medical history of well-controlled type 2 diabetes mellitus and hypertension. Upon examination, bilateral ptosis is noted with a full range of eye movements. The patient’s speech begins to slur at 15 when asked to count upwards. During the examination, he spits out upper airway secretions three times but is able to swallow half a glass of water. The neurological examination of the rest of his cranial nerves, upper and lower limbs are unremarkable. The FVC is 85% of predicted. What is the most appropriate treatment?
A 32-year-old man visits his doctor, feeling very distressed. He woke up that morning with a sensation that his right cheek was feeling heavy. He immediately saw himself in the mirror and was horrified to find that his face was twisted. He could not close his right eye. Saliva drooled from the angle of his mouth on the right side. He was extremely distressed to note that when he tried to smile his mouth deviated to the left side. There is some sense of dizziness and hearing is muffled on the right side. His father had had a stroke 4 weeks ago. The only medication of note is the antihypertensive medication.
On examination, his blood pressure is 150/80 mmHg, his pulse is 80/min and he is anxious. Examination of his right ear reveals a few tense vesicles in his right ear and there is right-sided facial nerve palsy.
What is the most likely diagnosis?