Archive for September, 2012

A college student who was previously in good health develops transient bladder incontinence that resolves slowly over a period of several weeks. Three months later, after breaking up with her boyfriend, she presents to her doctor’s office complaining of blurry vision in her right eye that developed suddenly. Which of the following is the most likely diagnosis?

a. Somatoform disorder

b. Myasthenia gravis

c. Major depression

d. Dissociative identity disorder

e. Multiple sclerosis

the answer is below…

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For the past year, a 12-year-old boy has had recurrent episodes of swelling of his hands and feet, which has been getting worse recently. These episodes occur following exercise and emotional stress, last for 2 to 3 days, and resolve spontaneously. The last episode was accompanied by abdominal pain, vomiting, and diarrhea. The results of routine laboratory workup are normal. An older sister and a maternal uncle have had similar episodes, but they were not given a diagnosis. He presents today with another episode as shown in the photographs below. Which of the following is the most likely diagnosis?

a. Systemic lupus erythematosus

b. Focal glomerulosclerosis

c. Congenital nephrotic syndrome

d. Hereditary angioedema

e. Henoch-Schönlein purpura

the answer is below…

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A boy has the onset of difficulty walking at 16 months. Reflexes are decreased. Over the course of several months, the patient becomes dysarthric and mental functioning decreases. Testing reveals that the patient has a deficiency of arylsulfatase A. Which of the following is the most likely diagnosis?

a. Sandhoff’s disease

b. Tay-Sachs disease

c. Gaucher’s disease

d. Metachromatic leukodystrophy

e. McArdle’s disease

the answer is below…

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A 19-year-old man goes swimming in an inland pond in Puerto Rico. Within a few days, he notices itching of his skin over several surfaces of his body. He is unconcerned until several weeks later when he develops lancinating pains extending down his legs and all of his toes. Over the course of just a few days, he develops paraparesis and problems with bladder and bowel control. Within one week, he is unable to stand and has severe urinary retention. Which of the following is the most appropriate plan of action on an emergency basis?

a. Initiate anticoagulation

b. Perform sensory-evoked potential testing

c. Order an MRI scan

d. Place a cervical collar

e. Perform spinal angiography

the answer is below…

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A 61-year-old man, who smokes five packs of cigarettes per day and has hypertension, had an abdominal aortic aneurysm repair 8 hours ago. The surgery went very well, and there were no reported perioperative complications. Now the patient is unable to move his legs and states that they are “numb.” On examination, he has a flaccid paresis of both lower extremities and has impaired pinprick sensation to a T9 level bilaterally. Joint proprioception is normal. Which of the following is the most likely diagnosis in this case?

a. Cerebral stroke

b. Conversion disorder

c. Multiple sclerosis

d. Spinal cord compression

e. Spinal cord infarct

the answer is below…

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A patient with a meningitis and facial weakness of unknown etiology had been given isoniazid and rifampin. There was no improvement and she is treated with high-dose steroids. Within 1 week of the introduction of prednisone, she develops pain radiating down the back of her right leg and has difficulty dorsiflexing the right foot. This new symptom most likely represents which of the following disorders?

a. Borrelia radiculopathy

b. Diabetic mononeuritis multiplex

c. Isoniazid neuropathy

d. Rifampin toxicity

e. Tuberculous radiculopathy

the answer is below…

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A 35-year-old man injured his thoracic spine in a motor vehicle accident 2 years ago. Initially he had a bilateral spastic paraparesis and urinary urgency, but this has improved. He still has pain and thermal sensation loss on part of his left body and proprioception loss in his right foot. There is still a paralysis of the right lower extremity as well. This patient most likely has which of the following spinal cord conditions?

a. Brown-Séquard (hemisection) syndrome

b. Complete transection

c. Posterior column syndrome

d. Syringomyelic syndrome

e. Tabetic syndrome

the answer is below…

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A 32-year-old woman is brought to the emergency room by the police after she was found standing in the middle of a busy highway, naked, commanding the traffic to stop. In the emergency room she is agitated and restless, with pressured speech and an affect that alternates between euphoric and irritable. Her father is contacted and states that this kind of behavior runs in the family. Which of the following is the most likely diagnosis?

a. Delirium

b. Bipolar disorder, manic

c. Bipolar disorder, mixed state

d. Cyclothymia

e. Schizophrenia

the answer is below…

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Dokter Arogan

A life in medicine is a peculiar one, and we who pursue its course are also peculiar.

Posting kali ini mungkin terasa sangat aneh. Dan akan menjadi lebih aneh karena yang menulis seorang dokter. Tetapi ini adalah proses otokritik terhadap saya pribadi, juga terhadap kolega-kolega saya.

Dokter itu arogan.

Wow. Benarkah? Kok bisa Dok? -sebagian reaksi-

Benar. Baru nyadar, Dok? -sebagian (besar) reaksi-

Mungkin memang benar. Tetapi ijinkan saya yang baru seumur jagung berprofesi dokter ini mencoba membaca fenomena ini dari sudut pandang saya pribadi. Dan pada akhirnya saya akan menyerahkan semua opini pada para pembaca budiman.

Bagi saya, dokter, bila dibandingkan dengan profesi lain, memiliki ego yang lebih besar. Lihatlah mereka yang telah menjadi role model dokter selama beberapa dekade terakhir, percaya diri, sukses, pencapaian besar dalam hidup. Faktor-faktor yang menyeret gairah sebagian besar anak muda untuk meraih profesi dokter. Sejak awal pendidikan, ada warisan turun-temurun yang diletakkan di pundak para calon dokter, PRIDE.

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A 35-year-old man with multiple sclerosis presents with blurry vision. Examination reveals that the medial rectus muscle fails to move synchronously with the contralaterallateral rectus muscle on attempted gaze to either size. When each eye is tested individually, medial rectus function is relatively preserved. In addition, prominent nystagmus is present in the abducting eye. Evidence of internuclear ophthalmoplegia (INO) indicates which of the following?

a. A mesencephalic or pontine injury

b. Thalamic hemorrhage

c. Cerebellar dysfunction

d. Cortical injury in the frontal eye fields

e. Medullary infarction

the answer is below…

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