06-29-2016, 05:58 PM
A 23-year-old woman with sickle cell disease is brought to the emergency department after becoming obtunded; she has a 2-day history of cough and fever. Her temperature is39.3°C (102.7°F), pulse is 128/min, respirations are 28/min, and blood pressure is 98/60 mm Hg. She appears stuporous. She is intubated and mechanically ventilated. There is moderate nuchal rigidity. Right basilar crackles are heard on auscultation. Hematocrit is 21% with many nucleated erythrocytes, and leukocyte count is 24,000/mm3. Which of the following is the most appropriate next step in management?
A ) Administration of antibiotics
B ) Administration of dopamine
C ) CT scan of the head wrong
D ) Transfusion of 3 units of packed red blood cells
For each patient who has transient episodes of acute neurologic dysfunction, select the most likely diagnosis.
A ) Cataplexy
G ) Simple partial (motor) seizure with generalization
B ) Complex partial seizure wrong
H ) Simple partial (motor) seizure without generalization
C ) Migraine
I ) Simple partial (sensory) seizure with generalization
D ) Panic attack
J ) Simple partial (sensory) seizure without generalization
E ) Photomyoclonic seizure
K ) Syncope
F ) Primary generalized seizure
L ) Transient ischemic attack
35. An otherwise healthy 52-year-old man has episodes of loss of consciousness preceded by twitching of the right thumb, then the hand, the wrist, the elbow, and the shoulder. The spread from thumb to shoulder takes about 20 seconds. He then finds himself on the floor; he often bites his tongue and urinates during these episodes.
A 10-year-old girl is brought to the physician by her parents after the Thanksgiving holiday break because of a 4-day history of rapid, irregular involuntary movements of her face, trunk, and extremities. Her parents say that during this period, she has been anxious and irritable and has had headaches. She seems to be worrying obsessively about things that formerly would not have worried her. She has no history of serious illness except for migratory joint pain that occurred in the early fall. Examination shows restless-appearing,generalized involuntary movements of the face, trunk, and extremities. Which of the following is the most likely cause of this patient's symptoms?
A ) Autoimmune disorder of the basal ganglia
B ) Conversion disorder
C ) Heavy metal toxicity
D ) Hypercalcemia
E ) Hypothyroidism
F ) Tandem repeat mutation on chromosome 4 wrong
A 57-year-old woman comes to the physician because of a 3-month history of gradually progressive weakness in the shoulder and hip muscles. She has hypothyroidism treated with thyroxine but is otherwise healthy. Her vital signs are within normal limits. Neurologic examination shows moderate bilateral weakness of the deltoid, biceps, triceps, psoas, glutei, and quadriceps muscles. The remainder of the examination shows no abnormalities. Her erythrocyte sedimentation rate is 85 mm/h, and serum creatine kinase activity is2456 U/L. Complete blood count and urinalysis are within normal limits. Which of the following is the most appropriate next step in diagnosis?
A ) Quantitative sensory testing
B ) Electromyography and nerve conduction studies
C ) MRI of the spinal cord
D ) Skin biopsy wrong
E ) Lumbar puncture
A previously healthy 32-year-old woman comes to the physician because of a 1-week history of progressive sensory loss. Initially, only her feet felt numb, but the loss of sensation has slowly ascended symmetrically to the umbilicus. She also has had urinary urgency and frequency, nocturia, and the perception of a tight band-like sensation around her midabdominal region. Examination shows slowing of left eye adduction during saccadic movement of the eyes to the right. There is diffuse hyperreflexia. Sensation to pinprick is decreased to the level of the umbilicus. Which of the following is the most likely diagnosis?
A ) Adrenal leukodystrophy
B ) Cytomegalovirus polyradiculopathy
C ) Guillain-Barré syndrome wrong
D ) Multiple cerebral infarcts
E ) Multiple sclerosis
An otherwise healthy 52-year-old financial advisor comes to the physician because of a 6-week history of progressive right hand weakness that is interfering with his ability to write. There is no history of trauma to the hand. He takes no medications. He is 180 cm (5 ft 11 in) tall and weighs 90 kg (199 lb); BMI is 28 kg/m2. Examination of the right hand shows decreased active abduction of the small and index fingers. He cannot cross and uncross his right index and middle fingers, and he is unable to pinch the palmar aspect of the right thumb against the radial side of the index finger without flexing the interphalangeal joint of the thumb to provide strength. Active flexion of the interphalangeal joints of the right hand is 5/5. Sensation over the entire dorsal aspect of the hand is normal. The remainder of the neurologic examination shows no focal findings. Which of the following is the most appropriate next step in diagnosis?
A ) MRI of the brachial plexus
B ) MRI of the neck
C ) Electrophysiological studies
D ) Biopsy of the sural nerve
E ) Carpal tunnel release worng
A previously healthy 24-year-old woman is brought to the emergency department by her brother 1 hour after a generalized tonic-clonic seizure that lasted 5 minutes. The patient and her brother emigrated from Central America6 months ago. She takes no medications. She is drowsy but cooperative. Her temperature is 37.1°C (98.8°F), pulse is 80/min, respirations are 18/min, and blood pressure is 150/90 mm Hg. Examination and laboratory studies show no other abnormalities. Toxicology screening is negative. A CT scan of the head with contrast is shown. Which of the following is the most likely diagnosis?
A ) Behçet syndrome
B ) Central nervous system lymphoma
C ) Metastatic carcinoma
D ) Neurocysticercosis
E ) Progressive multifocal leukoencephalopathy wrong
F ) Toxoplasmosis
G ) Tuberculous meningitis
answers with an explanation, please