Archives: Medical Student Finals

MSFinals-3081

A 70-year-old man is admitted at the request of his family due to a 3-month history of increasing confusion and unsteady gait. They have also noted intermittent jerking movements of both upper limbs. He was previously healthy and till the onset of symptoms, had continued to work part-time as a carpenter. On examination, he is not orientated to time, person or place. Myoclonic jerks of both upper limbs are noted together with non-specific cerebellar signs. CT brain and blood work-up for common causes of dementia is normal.
Which of the following tests will help in diagnosis?

MSFinals-3082

An 87-year-old woman who lives alone is found wandering in the street, she is unable to remember her way home. Past medical history of note includes hypertension for which she takes lisinopril and hydrochlorothiazide. She is known to Social Services having been in trouble for stealing from a local grocery store earlier in the year, and for yelling at a neighbor who complained about her loud music. On examination she is agitated and socially inappropriate, she has been incontinent of urine. During your testing she repeats what you say and appears to be laughing at you. Responses to your questions tend to lack fluency and she has trouble naming simple objects. There is rigidity and increased tone on motor examination.
Bloods:
Investigation Result Normal value
Haemoglobin 130 g/l 135–175 g/l
White cell count (WCC) 5.2 × 109/l 4–11 × 109/l
Platelets 250 × 109/l 150–400 × 109/l
Sodium (Na+) 142 mmol/l 135–145 mmol/l
Potassium (K+) 4.5 mmol/l 3.5–5.0 mmol/l
Creatinine 190 μmol/l 50–120 µmol/l
Computed tomography (CT) head scan – evidence of frontal atrophy
Which of the following diagnoses fits best with this clinical picture?

MSFinals-3083

A 55-year-old woman presented to her GP with a four month history of progressive distal sensory loss and weakness of both legs and arms. The weakness and numbness had extended to the elbows and knees.

On examination, cranial nerves and fundoscopy were normal. Examination of the upper limb revealed bilaterally reduced tone and 3/5 power.

Lower limb examination revealed some mild weakness of hip flexion and extension with marked weakness of dorsiflexion and plantarflexion. Both knee and ankle jerks were absent and both plantar responses were mute. There was absent sensation to all modalities affecting both feet extending to the knees.

A lumbar puncture was performed and yielded the following data:

Opening pressure 14 cm H2O (5-18)

CSF protein 0.75 g/L (0.15-0.45)

CSF white cell count 10 cells per ml (<5 cells) CSF white cell differential 90% lymphocytes – CSF red cell count 2 cells per ml (<5 cells) Nerve conduction studies showed multifocal motor and sensory conduction block with prolonged distal latencies. What is the likely diagnosis in this patient?

MSFinals-3084

A 78-year-old man comes to his doctor’s office with his daughter. His daughter reports that he has been increasingly forgetful, frequently forgetting appointments and sometimes leaving the stove on. He has also experienced a few instances of urinary incontinence. The patient’s neurological examination is unremarkable except for a slow gait, reduced step height, and decreased foot clearance. Based on these findings, what is the most probable diagnosis?

MSFinals-3085

A 25-year-old man develops a wrist drop after suffering a spiral fracture of the humerus while playing football. As a result, he is unable to extend his wrist and his hand hangs flaccidly. Which nerve is the most likely to have been damaged?

MSFinals-3086

A 24-year-old man comes to the Emergency Department with a hand injury sustained during a bar brawl. He has a wound with glass fragments embedded in it. On examination, he is unable to make a fist, and there is no sensation in his thumb, index, and middle fingers. There are no other neurological deficits in his arms or other limbs.
Which nerve is the most likely culprit in this patient’s condition?

MSFinals-3087

A 50-year-old man, presenting with changes in mood and behavior that have been developing over the past 8 years, is brought to the clinic by his son. The son also reports that his grandfather died from Alzheimer’s disease at the age of 52. The patient has recently experienced aphasia, disorientation, and memory loss. He passes away a few weeks later. A brain biopsy shows cortical atrophy with widening of the cerebral sulci.
What is the most probable mechanism that contributed to the development of this patient’s condition?

MSFinals-3052

A 57-year-old man with a history of atrial fibrillation presents to his local Emergency Department with sudden loss of vision in the lower left quadrant of his visual field in both eyes. A CT scan of his head reveals an area of infarction in his brain, leading to a diagnosis of acute ischemic stroke. Which blood vessel is most likely occluded?

MSFinals-3053

A 72-year-old woman who has smoked her entire life presents with a complaint of drooping of the left eyelid. Upon examination, there is ptosis of the left eyelid and a small pupil that responds to light but does not dilate. The right eye appears normal.
What is the probable diagnosis?

MSFinals-3054

A woman brings her middle-aged husband to see you. She is worried about his recent forgetfulness. She also reveals that he has been experiencing hallucinations of small children playing in the house. On examination, there is nothing significant to note except for a mild resting tremor in the hands (right > left).

What is the most probable diagnosis?