Archives: Medical Student Finals

MSFinals-3132

A 25-year-old female comes to the clinic with sudden onset of left foot drop. Upon examination, it is found that she has weakness in ankle dorsiflexion and eversion. There is also a loss of sensation over the dorsum of her foot. All reflexes are present and plantars flexor. Which nerve is most likely to be affected?

MSFinals-3133

A 70-year-old man presents with symptoms including poor sleep. He reports an itching and crawling sensation affecting his legs with an overwhelming urge to move them. His wife reports that he tosses and turns all night, often pacing the room, and constantly rubs his legs. Things only improve with the break of dawn. He seems tired all day as a consequence of the disturbed sleep at night. The only past medical history of note is diverticular disease, from which he has been troubled by periodic iron deficiency anaemia. Neurological examination is unremarkable.

Bloods:
Investigation Result Normal value
Haemoglobin 101 g/l (microcytic) 135–175 g/l
White cell count (WCC) 5.1 × 109/l 4–11 × 109/l
Platelets 285 × 109/l 150–400 × 109/l
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.1 mmol/l 3.5–5.0 mmol/l
Creatinine 124 μmol/l 50–120 µmol/l
Fasting glucose 5.8 mmol/l < 7 mmol/l
Which of the following diagnoses fits best with this clinical picture?

MSFinals-3134

A 20-year-old man arrives at the Emergency Department with an ‘ape hand’ deformity after being stabbed in his arm. Upon examination, he is found to have median nerve damage and is unable to abduct his thumb. What other function is likely to be impaired in this patient?

MSFinals-3135

A 57-year-old male with diabetes comes to the clinic complaining of weakness in his left foot. He has noticed a dragging sensation when walking for the past two days. The patient has been diabetic for two years and has had no previous abnormalities during annual check-ups.

During the examination, the patient is unable to dorsiflex his left foot and evert it. However, his right foot is unaffected, and plantar flexion and inversion are normal. What sensory abnormality would you anticipate finding in conjunction with this motor defect?

MSFinals-3136

An epileptic teenager is seeking advice regarding their ability to drive following a seizure six months ago. On further enquiry, you discover that the seizure was in response to a medication change, which also took place six months ago and since being put back on their original medication, they have been seizure-free.
What advice is appropriate for this patient?

MSFinals-3137

A 42-year-old woman comes to the Neurology Clinic with complaints of painful unilateral visual disturbance, ataxia, and sensory deficit. She is diagnosed with multiple sclerosis (MS) after undergoing magnetic resonance imaging (MRI) and is started on steroid treatment, followed by disease-modifying therapy. Her disease is stable after six months, and she can manage her daily activities without significant problems. She used to drive a car but has not done so since her diagnosis. She is now curious about her driving situation.

What are the most appropriate steps to take regarding her driving circumstances?

MSFinals-3138

A 55-year-old man comes to the doctor complaining of double vision. Upon examination, his eye is turned down and out, and he has limited adduction, elevation, and depression of the eye, as well as ptosis. Additionally, his pupil is fixed and dilated. What is the probable diagnosis?

MSFinals-3139

A 65-year-old male complains of a burning sensation in his feet that has been gradually increasing over the past six months. Upon examination, his cranial nerves and higher mental function appear normal, as do his bulk, tone, power, light touch and pinprick sensation, co-ordination, and reflexes in both his upper and lower limbs. What condition could these clinical findings be indicative of?

MSFinals-3140

What is the ionic event that occurs just before the creation of fusion pores during neurotransmitter synaptic release?