Archives: Medical Student Years 1-3

MS-4068

A 67-year-old man comes to the hospital with a sudden onset of vision changes while watching TV. He has a history of hypertension and atrial fibrillation but admits to poor adherence to his medication regimen.

During the eye exam, there are no apparent changes in the sclera. The visual field test shows a homonymous quadrantanopia with a loss of the left inferior aspect of vision. All eye movements are normal, pupils are equal and reactive to light, and fundoscopy appears normal.

Based on these findings, where is the most likely location of the lesion in this patient?

MS-4072

A 28-year-old woman presents to the Emergency Department complaining of a headache and blurred vision. The headache began 2 days ago and is aggravated by coughing and changing position. The blurred vision started 5 hours ago. She has no history of head injuries and has never experienced these symptoms before. Her BMI is 27 kg/m² and she is currently taking the combined oral contraceptive pill.

Upon examination, the patient has difficulty abducting her left eye. Fundoscopy reveals bilateral papilloedema.

Vital signs:
Blood pressure: 130/90 mmHg
Heart rate: 80 bpm
Respiratory rate: 16/min

What is the most probable diagnosis?

MS-4071

A 35-year-old man presents with a gradual onset loss of feeling in his feet. His past medical history includes alcohol misuse.

Upper and lower limb motor examinations identify bilateral extensor plantar reflexes with absent knee jerks. Sensory examination identifies reduced sensation to vibration and proprioception distal to the elbows and knees, and reduced light touch sensation in a stocking distribution.

Blood tests:

Hb 118 g/L Male: (135-180)
Platelets 170 * 109/L (150 – 400)
MCV 112 fL (80 – 100)
Fasting blood glucose 4.5 mmol/L (3.9-5.6)
Serum vitamin B12 125 ng/L (190-950)
Serum folate 2.3 ng/ml (2.7-17.0)

Which affected areas of the nervous system are causing his symptoms?

MS-4077

A 37-year-old woman presents with blurring of vision on lateral gaze. She had a previous episode of pain on eye movement and difficulty seeing red colors six months ago, which resolved on its own after a week.

She sought consultation with a neurologist who conducted an examination. The left eye failed to adduct on rightward gaze, while the right eye exhibited nystagmus. Leftward, upward, and downward gazes were unremarkable. The pupils were equal and reactive to light.

Peripheral examination yielded no significant findings. An MRI brain scan was ordered, and the results are pending.

Based on this presentation, where is the most likely location of the lesion?

MS-4078

A 63-year-old woman with a longstanding history of type 2 diabetes mellitus, hypertension, and hypercholesterolemia experienced sudden weakness in her right lower leg while preparing breakfast. She had a similar episode two days ago, which resolved after an hour. Her son brought her to the emergency department, where she reported her symptoms to the attending physician. The patient can speak well and fully comprehend what the doctor tells her. Upon examination, the doctor noted decreased touch sensation in her right leg. A non-contrast computed tomography (CT) scan was unremarkable, but a repeat CT scan after 12 hours revealed an area of hypo-attenuation in a region of the brain. Which artery of the cerebral circulation is most likely to be occluded in this patient?

MS-4075

A 60-year-old man visits an after-hours medical facility in the late evening with a complaint of a severe headache that is focused around his left eye. He mentions experiencing haloes in his vision and difficulty seeing clearly. The patient has a medical history of hypertension and diabetes. During the examination, the sclera appears red, and the cornea is hazy with a dilated pupil.

What condition is the most probable diagnosis?

MS-4070

A 75-year-old male has been admitted to the stroke ward after experiencing a stroke 2 days ago. During a mini mental state examination, it was observed that the patient struggled with repeating sentences. Upon further assessment, the doctor discovered that the patient had difficulty with speech repetition. Nevertheless, the patient had no issues with speech comprehension or production during conversation.

What could be the probable cause of the patient’s symptoms?

MS-4076

A 49-year-old man visits his GP with complaints of weakness in his arms and legs that he first noticed 3 weeks ago. The symptoms have been progressively worsening since then.

Upon conducting a neurological examination, the doctor observes spastic weakness in all four limbs, slight muscle wasting, fasciculations, and hyperreflexia with up-going plantar reflexes. The patient’s speech and eye movements are normal, and there is no evidence of ptosis. All sensation is intact.

What is the most likely diagnosis for this patient based on the examination findings?

MS-4066

A 73-year-old male visits the GP following a recent fall. He reports experiencing decreased sensation in his penis. During the clinical examination, you observe reduced sensation in his scrotum and the inner part of his buttocks. You suspect that the fall may have resulted in a sacral spinal cord injury.

What dermatomes are responsible for the loss of sensation in this case?

MS-4074

A 42-year-old woman visits her doctor complaining of increased fatigue, especially towards the end of the day. Her husband notices visible signs of tiredness, with her eyes almost closed.

During the examination, the doctor observes a mass on the front of the neck and mild ptosis on both sides. To further investigate, the doctor instructs the patient to look down for a brief period and then return to primary gaze. Bilateral eyelid twitching is present upon returning to primary gaze.

What is the most commonly associated antibody with the probable diagnosis?