Cases Flashcards

1
Q

18/yo male student presents with severe headache and fever that he has had for 3 days. Examination revels photophobia and neck stiffness.

A

Meningitis

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2
Q

56y/o man presents to A&E with headache, fever, blurred vision and somnolence followed shortly by unresponsiveness to verbal commands. For the last 2wks he had been feeling ill and had decreases appetite and myalgia. 3 days prior to presentation he experienced intermittent confusion, severe headache and fever. Examination was limited by a tonic-clonic seizure.

A

Encephalitis

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3
Q

76y/o woman is brought to her GP by her daughter as she is becoming more forgetful. She used to pay her bills independently and enjoyed cooking but has recently received overdue notices from utility companies and found it difficult to prepare a balanced meal. When her children express their concerns, she becomes irritable and resists their help. No significant PMHx. MMSE score is 20/30.

A

Alzheimer’s disease

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4
Q

65y/o man presents with difficulty in decision-making and planning, which is of abrupt onset and occurs 3mths after a stoke. PMHx includes hypertension and angina. Over time there has been a fluctuating stepwise reduction in cognitive function.

A

Vascular dementia

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5
Q

78y/o woman presents with confusion, agitation and visual hallucinations. She has become progressively confused over the past 2 years and has had trouble managing her affairs, such as shopping and paying bills. Initially she struggled to follow a conversation and found herself getting lost on several occasions. She started to shuffle about 6mths ago and had difficulty getting out of chairs, and getting dressed to go out seemed to take hours.

A

Lewy-body dementia

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6
Q

58y/o male teacher developed dystopia, spelling errors, impaired comprehension of reading and conversation. He also has impaired attention, planning and organisation, along with declining self-care, child-like behaviour and altered social habits (e.g. eating meals with his fingers).

A

Frontal-Temporal dementia

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7
Q

16y/o boy presents to A&E with a 1st-time seizure after attending an all night party and consuming alcohol. Witnesses described the seizure as beginning abruptly with bilateral limb stiffening, followed by jerking movements in all limbs; the patient has no memory of the event but recalls a strange smell prior to the episode.

A

Epilepsy

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8
Q

44y/o male smoker presents with a 9-month history of severe headaches. These occur around his left eye and do not spread to anywhere else. He tells you he suffers around 4 or 5 a day for a week, followed by a month without any headaches before they start up again in a similar fashion.

A

Cluster headache

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9
Q

32y/o woman presents with a 13yr history of 1-3 attacks per month of a disabling pain over her right temple. She feels nauseous during these attacks and finds she has to stop what she’s doing and lie in a darkened room. She notices “funny lines” appearing prior to each attack.

A

Migraine with aura

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10
Q

Middle aged woman presents with a complaint of frequent (once or twice daily for 3wks), brief (lasting several seconds) episodes of intense, sharp left-sided jaw pain. She has experienced these attacks for several years, but they had previously been relatively rare. She says that episodes are sometimes brought on by eating but can occur without an apparent stimulus.

A

Trigeminal neuralgia

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11
Q

75 y/o man presents with problems walking that have developed over the previous 2yrs, consisting of slow gait, imbalance (especially on turning), short stride length and gait initiation failure. He reports urinary frequency, occasional urge incontinence and some memory loss. On examination, his symptoms are symmetrical and much more prominent in the lower half of the body, with relative sparing of hand function and normal facial expressiveness.

A

Hydrocephalus

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12
Q

60y/o man presents with progressive headache and cognitive decline. A MRI of the brain without gadolinium enhancement demonstrates a large extra-axial lesion that is similar intensity to brain on T1 images.

A

Meningioma

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13
Q

35y/o right-handed man presents with a partial seizure involving jerky movements of his right arm and the right side of his face. He also reports left-sided headaches for a few months and clumsiness of his right hand. On examination he has a subtle facial droop and pronator drift on the right side.

A

Astrocytoma

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14
Q

53y/o black woman complains of a sudden, excruciating headache while sitting at work. The headache is diffuse, intense and accompanied by N&V. She describes it as the worst headache of her life, before losing consciousness.

A

Subarachnoid haemorrhage

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15
Q

Young man is brought to A&E after being involved in a high-speed motor vehicle accident. He was an unrestrained driver, and no airbags were deployed. He has multiple areas of abrasion, lacerations and ecchymosis about his scalp and face. On neurological examination, he does not open his eyes to painful stimuli; he is intubated and he withdraws his left side to pain. q

A

Subdural haemorrhage

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16
Q

28y/o woman who has a 10yr pack history presents with subacute onset of cloudy vision in 1 eye, with pain on movement of that eye. She also notes difficulty with colour discrimination, particularly of reds. She was treated for a sinus infection 2wks ago and on further history recalls that she had a 3wk history of unilateral homebody paraesthesias during the week of her final exams 6 years ago. She occasionally has some tingling on that side if she is overly tired, stressed, or hot.

A

MS

17
Q

65y/o man presents with progressive slurred speech with nasal quality, and episodes of choking on liquids, for the last 4 to 5mths. Neurological examination reveals facial, palatal and tongue weakness; tongue muscles exhibit wasting and fasciculations; dysarthria; hypo phonic speech and brisk reflexes throughout.

A

ALS

18
Q

76 y/o man reports double vision for the past 2mths. Within the past 2wks he has developed bilateral ptosis, which is so severe at times that he holds his eyes open to read. He is unable to drive due to the ptosis and diplopia. His symptoms are generally better in the morning and progress throughout the day.

A

Myasthenia gravis

19
Q

69y/o man presents with a 1yr history of mild slowness and loss of dexterity. His handwriting has become smaller and his wife feels his face is less expressive and his voice softer. Over the last few months he has developed a subtle tremor in the right hand, noted while watching television.

A

Parkinson’s

20
Q

70y/o man is discovered by a family member to have difficulty speaking and comprehending spoken language, and an inability to raise his right arm. He was last known to be fully functional 1hr ago when the family member spoke to him by phone. There is a PMHx of hypertension and DM.

A

Stroke