Tests

Question 1

30 y/o Shooting pain from lower back down lateral R leg, worse w/ cough/straining, no bowel/bladder involvement. No weakness, reflexes normal, decreased sensation over dorsal foot, Straight leg raise positive. Ddx

Answer 1

L5 Radiculopathy

Dermatomal sensory changes, no UMN signs, normal ankle reflex -> L5 nerve roots

No further imaging

Question 2

Back pain red flags

Answer 2

Point tenderness, fever, h/o CA or trauma, bowel/bladder dysfunction. (NEED MRI)

Question 3

HIV pt w/ 3 weeks HA & neck pain, CD 4+ 74, on Bactrim, T 101 F, no neck stiffness, R side face weakness (upper & lower), tongue protrudes to L. Dx

Answer 3

(Cryptococcal) Meningitis
Inflammation of meninges = bilateral cranial nerve involvement

Cancer (lymphoma), abscess, other opportunistic (TB, Toxo)

Question 4

64 M PMH HLD on ASA, L inferior quandrant anopsia, L-sided neglect, agraphesthesia, asterognosia. Dx & Testing

Answer 4

R MCA stroke
Stat: NCCT, PT/PTT, Glucose -> tPA
24-48 hr: EKG, TTE (w/ bubble), Carotid u/s, MRIb & MRA