A 76-year-old man comes to his doctor complaining of difficulty speaking, swallowing, and experiencing sudden emotional outbursts of laughter or tears. Upon examination, the doctor observes a spastic tongue, an exaggerated jaw jerk, normal gag reflex, and bilateral upper motor neuron signs. What is the most probable diagnosis?
A 66-year-old man is referred to the Elderly Medicine Clinic with a 6-month history of changed behaviour. He has been hoarding newspapers and magazines around the house and refuses to change his clothes for weeks on end. His wife has noticed that he tells the same stories repeatedly, often just minutes apart. He has a new taste for potato crisps and has gained 4 kg in weight. On examination, his mini-mental state examination (MMSE) is 27/30.
What is the most likely diagnosis?
A 10-year-old boy presents to the Paediatric Clinic with progressive bilateral upper leg weakness. He experiences difficulty climbing stairs and is unable to participate in school sports due to severe muscle cramps during exertion. There is a family history of muscle problems on his mother’s side of the family, and the paediatrician suspects a genetic muscular dystrophy. What is the most suitable initial investigation?
What is the neurotransmitter that opposes the effects of dopamine in the basal ganglia?
A 32-year-old man presents to the Emergency department with a three-day history of paraesthesia in his feet and hands. He has also noticed weakness in his thighs, particularly when walking down stairs, and weakness affecting his shoulders. Prior to this, he had been well, except for a mild case of gastroenteritis after eating Chinese food. On examination, he appears anxious, but cranial nerve examination and fundoscopy are normal. Upper limb examination reveals reduced tone and absent reflexes bilaterally at both wrists. Lower limb examination shows 2/5 power, absent reflexes, and reduced sensation affecting both feet. A lumbar puncture is performed, yielding the following results: opening pressure 14 cmH2O (5-18), CSF protein 0.40 g/L (0.15-0.45), CSF white cell count 4 cells per ml (<5 cells), CSF red cell count 2 cells per ml (<5 cells), and negative CSF oligoclonal bands. What is the diagnosis for this patient?
A 28-year-old patient presents with progressive weakness of the arms and legs over 1 week. Three weeks earlier, she had an episode of diarrhoea lasting 5 days. Examination confirms distal weakness and ‘glove-and-stocking’ sensory loss.
What is the most likely diagnosis?
A 25-year-old university student exhibits involuntary head twitching and flicking of his hands. He also says that he suffers from embarrassing grunting which can affect him at almost any time. When he is in lectures at the university he manages to control it, but often when he comes home and relaxes the movements and noises get the better of him. His girlfriend who attends the consultation with him tells you that he seems very easily distracted and often is really very annoying, repeating things which she says to him and mimicking her. On further questioning, it transpires that this has actually been a problem since childhood. On examination his BP is 115/70 mmHg, pulse is 74 beats/min and regular. His heart sounds are normal, respiratory, abdominal and neurological examinations are entirely normal.
Investigations:
Investigation Result Normal value
Haemoglobin 129 g/l 135–175 g/l
White Cell Count (WCC) 8.0 × 109/l 4–11 × 109/l
Platelets 193 × 109 /l 150–400 × 109/l
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.5 mmol/l 3.5–5.0 mmol/l
Creatinine 95 μmol/l 50–120 µmol/l
Alanine Aminotransferase (ALT) 23 IU/l 5–30 IU/l
Which one of the following is the most likely diagnosis?
The ward nurses express concern about a 46-year-old man who was admitted with jaundice yesterday. They discovered him in the linen cupboard, disoriented and searching for his luggage so he could check-out before midday. Upon your arrival, he is still confused and unsteady, with a tachycardia of 120 bpm and nystagmus. However, he poses no immediate danger to himself or others. Which medication would be suitable for this patient?
What is contraindicated for patients with head injury?
A 35-year-old man presents with a 4-month history of declining physical performance at work, accompanied by dysarthria and clumsiness. During the examination, he appears anemic and has hepatomegaly and Kayser-Fleischer rings in his cornea. He has a detectable liver edge. He denies excessive alcohol consumption and has no history of foreign travel, intravenous drug use, or unprotected sexual intercourse. His weekly alcohol intake is 0-2 units. He reports that his father passed away from a psychiatric illness in his mid-forties. What is the most probable diagnosis?