A 70-year-old woman with a long history of arthritis presents with worsening difficulty walking. Upon examination, she displays several neurological abnormalities in her lower limbs. However, her upper limbs and cranial nerves appear normal. An MRI scan reveals a ruptured intervertebral disc at the L3-4 level. The diagnosis is cauda equina syndrome.
What is a characteristic of this syndrome?
An 80-year-old man comes to the Emergency Department with a progressive decline in mental status and a past medical history of worsening gait and frequent falls. An MRI scan shows enlargement of the ventricular system, suggesting hydrocephalus. What other symptom would indicate a diagnosis of normal pressure hydrocephalus?
A 68-year-old man was watching TV at home and had a fit which lasted for approximately ten minutes. His wife was with him at home and reports that there was no incontinence or limb jerking. An electrocardiogram (ECG) shows left bundle branch block (LBBB). The patient denies any shortness of breath or chest pain before or after the event, and his vital signs are stable. A high-sensitivity troponin assay performed upon admission is negative. The patient is a non-smoker, suffers from well-controlled hypertension and has no significant family history. He is a retired plumber.
What is the next best investigation for this patient?
A diabetic woman attends for an ultrasound scan during her third trimester of pregnancy. The physician reporting the scan calculates an amniotic index >95th centile and diagnoses polyhydramnios.
What volume of amniotic fluid is considered to be consistent with polyhydramnios?
A 25-year-old patient with type 1 diabetes mellitus attends clinic for pre-pregnancy counselling with regard to her glycaemic control.
Which one of the following is the best test that will help you to advise the patient?
You are on your general practice placement, and a pregnant woman attends for a routine antenatal check-up. You examine her abdomen and find that her abdomen is distended up to her umbilicus. Your general practitioner asks you how many weeks you think she is, but you do not have a measuring tape.
How many weeks would you estimate her gestation to be if she was in her mid-30s?
A 37-year-old man comes to the Emergency Department complaining of left-sided hearing loss and tinnitus that have been ongoing for three months. He also reports experiencing dizziness, which has now progressed to difficulty walking steadily. Audiometry confirms sensorineural hearing loss in his left ear, and a contrast magnetic resonance imaging scan indicates that he has a tumor with characteristics consistent with an acoustic neuroma. Which type of cell is linked to the excessive growth of an acoustic neuroma?
A 65-year-old man presents to his General Practitioner with back pain. The pain has come on gradually over several weeks and is getting worse. He denies any shooting pain down his legs. He has a past medical history of diabetes mellitus and hypertension. He was also diagnosed with localised prostate cancer five years ago and was treated with radiotherapy as he declined surgery. The prostate showed a significant reduction in size following the radiotherapy. On examination, there is a mild reduction in power in his legs and reduced anal tone on digital rectal examination.
Which imaging modality would be most useful to perform for this patient?
An 82-year-old man is brought to see his general practitioner by his daughter, who reports a 3- to 4- month history of falls, intermittent confusion and worsening urinary incontinence. On examination, the man has an abbreviated mental test score (AMTS) of 4/10 but is otherwise well. There is no focal neurological deficit, but he is unable to walk without the assistance of his daughter. Routine investigations, including FBC, U&Es, RBG, LFTs, TFTs, Ca2+ and ESR, are all within normal limits. The diagnosis is later confirmed by serial lumbar puncture studies.
What is the most likely diagnosis?
A 29-year-old soccer player hits the side of his head on a goal post while attempting to make a save. Initially, he seems disoriented but quickly recovers and walks off the field without assistance. However, after the game ends, approximately 60 minutes later, he experiences confusion and complains of a severe headache. He stumbles and falls before becoming drowsy and starting to lose consciousness. Emergency services are contacted.
Which artery is most likely to have been affected by the impact to this individual’s head?