As a Foundation Year 2 in general practice, you see a 35-year-old diabetic woman who complains of numbness and tingling in some of her fingers in her right hand. During examination, you observe that she has reduced sensation in her thumb, index and middle fingers in this hand. She also has some weakness in these fingers when she tries to flex them and make a fist, and there is some thenar muscle wasting. Her pulse is 80 bpm with a normal volume, and otherwise her skin, joints and bones appear totally normal. What is the most likely condition that she is suffering from?
MSFinals-2983
A 42-year-old male accountant suddenly collapsed at work, complaining of a severe headache and nausea. He had been feeling fine in the days leading up to this incident. He had a medical history of hypertension and took regular medication for it. He did not smoke or drink alcohol.
Upon arrival at the Emergency department, the patient had a Glasgow coma scale score of 12/15 (motor 6, vocal 3, eyes 3) and nuchal rigidity. His blood pressure was 145/85 mmHg, pulse was 90 beats per minute and regular, and temperature was 37.1°C. Heart sounds were normal and the chest appeared clear.
During cranial nerve examination, a left dilated unreactive pupil with oculoparesis of the left medial rectus was observed. Fundoscopy showed no abnormalities. There were no obvious focal neurological signs on examining the peripheral nervous system, although both plantar responses were extensor.
A lumbar puncture was performed, revealing straw-colored fluid with the following results: – Opening pressure: 15 cmH2O (normal range: 6-18) – CSF white cell count: 6 cells per ml (normal range: <5) – CSF red cell count: 1450 cells per ml (normal range: <5) – CSF protein: 0.46 g/L (normal range: 0.15-0.45) – Cytospin: Negative for cells
What is the most likely diagnosis for this patient?
MSFinals-2984
A 20-year-old woman arrives at the Emergency Department complaining of fever, headache, and feeling generally unwell for the past two days. She denies having a rash, neck stiffness, photophobia, or vomiting. Her vital signs are within normal limits. The medical team suspects she may have viral encephalitis and orders a computed tomography head scan and lumbar puncture for cerebrospinal fluid (CSF) analysis.
The initial CSF results confirm the suspected diagnosis, showing a normal opening pressure and CSF glucose level, with a slightly elevated white cell count, mostly lymphocytes, and a protein level of 0.6 g/l (normal value < 0.45 g/l). While waiting for the CSF culture results, what is the most appropriate management for this 20-year-old woman?
MSFinals-2985
What is the most common visual field defect associated with multiple sclerosis?
MSFinals-2986
A 49-year-old woman complains of weakness and difficulty breathing. These symptoms have been getting worse over the last three months and have now become so severe that she is unable to work. She has no history of any medical conditions.
During the examination, the patient appears pale. The only notable finding is a strange involuntary movement of her fingers when she closes her eyes. Her blood film shows the presence of multi-lobed neutrophils.
What clinical feature might be observed in this patient?
MSFinals-2955
A 48-year-old woman visits her doctor with complaints of painful tingling over the lateral side of her left hand upon awakening in recent weeks. She also reports experiencing clumsiness in her hand. Upon examination, the doctor notes reduced sensation on the palmar aspects of her left thumb, index, and middle and ring fingers, leading to a suspicion of carpal tunnel syndrome. What clinical examination would be most effective in confirming this diagnosis?
MSFinals-2956
A man in his early 50s presents with a painless lump in the right posterior triangle of his neck. He undergoes an excision biopsy under general anaesthetic. After the procedure, he experiences difficulty shrugging his right shoulder. Which nerve is most likely to have been affected during the surgery?
MSFinals-2957
A final-year medical student takes a history from a 42-year-old man who suffers from narcolepsy. Following this the student presents the case to her consultant, who quizzes the student about normal sleep regulation. Which neurotransmitter is chiefly involved in rapid eye movement (REM) sleep regulation?
MSFinals-2958
A 28-year-old woman presents with a 48-hour history of headache and malaise that has worsened in the last 6 hours. She has vomited twice and recently had a sore throat. Her general practitioner has been treating her with a topical anti-fungal cream for vaginal thrush. On examination, she is photophobic and has moderate neck stiffness. The Glasgow Coma Score is 15/15, and she has no focal neurological signs. Her temperature is 38.5 °C. A computed tomography (CT) brain scan is reported as ‘Normal intracranial appearances’. A lumbar puncture is performed and CSF results are as follows: CSF protein 0.6 g/l (<0.45), cell count 98 white cells/mm3, mainly lymphocytes (<5), CSF glucose 2.8 mmol/l (2.5 – 4.4 mmol/l), and blood glucose 4.3 mmol/l (3-6 mmol/l). What is the most likely diagnosis?
MSFinals-2959
A 19-year-old male has recently been diagnosed with schizophrenia. He was prescribed haloperidol, but after two weeks, he was discovered to be confused and drowsy. Upon examination, he was found to have a fever of 40.7°C, rigid muscles, and a blood pressure of 200/100 mmHg. What treatment would you recommend in this situation?