,
,
, 4|Page
investigations, what is the most appropriate next step? - ANSWER: intravenous
empirical antibiotics
A 12-year-old girl presents with a 3-day history of progressive dysarthria,
dysphagia, and weakness. The patient was well until 3 days prior to admission to
the hospital; at that time, she developed the onset and subsequent gradual
worsening of dysarthria. She attributed the dysarthria to a sore throat that she had
had about 2 weeks earlier. 3 days prior to admission, she also had the onset of mild
dysphagia; it mostly occurred with liquids. 24 hours prior to admission, she
developed weakness in both upper extremities, which increased and began to
involve the lower extremities. This limb weakness was neither worsened by
activity nor improved by rest. A nerve conduction study reveals a moderate degree
of mostly motor demyelinating peripheral neuropathy, highly suggestive of
Guillain- Barre. What statement best describes the patient's prognosis? -
ANSWER: Her rapidly evolving clinical course indicates a poor prognosis
A 45-year-old African American man with no significant past medical history
presents with a 1-hour history of left retroorbital headache. It is described as
excruciating, stabbing, sharp, and lancinating; it is rated as severe in intensity. He
denies any preceding infections, nausea, vomiting, photophobia, or osmophobia; he
also denies fever, chills, stiff neck, focal weakness, numbness, tingling, vision,
hearing, gait, or speech changes. He recalls a similar episode several months ago; it
lasted about a week, and it dissipated without complications. His physical exam is
remarkable for painful distress, lacrimation with conjunctival injection, nasal
congestion, rhinorrhea, left ocular miosis, and left forehead diaphoretic flushing.
What pharmacologic agent is the most beneficial for this patient at this time? -
ANSWER: Sumatriptan
A 48-year-old woman presents after a seizure. Prior to the seizure, she experienced
confusion and disorientation preceded by nausea, vomiting, and blurred vision.
Symptoms appeared after working for several hours in the garden under the sun.
Her medical history is significant for the presence of schizophrenia, for which she
takes chlorpromazine at bedtime. Her temperature is 41 C; BUN and creatinine are
elevated; and there is neutrophilia, hemoconcentration, and lactic acidosis. You
,
, 4|Page
investigations, what is the most appropriate next step? - ANSWER: intravenous
empirical antibiotics
A 12-year-old girl presents with a 3-day history of progressive dysarthria,
dysphagia, and weakness. The patient was well until 3 days prior to admission to
the hospital; at that time, she developed the onset and subsequent gradual
worsening of dysarthria. She attributed the dysarthria to a sore throat that she had
had about 2 weeks earlier. 3 days prior to admission, she also had the onset of mild
dysphagia; it mostly occurred with liquids. 24 hours prior to admission, she
developed weakness in both upper extremities, which increased and began to
involve the lower extremities. This limb weakness was neither worsened by
activity nor improved by rest. A nerve conduction study reveals a moderate degree
of mostly motor demyelinating peripheral neuropathy, highly suggestive of
Guillain- Barre. What statement best describes the patient's prognosis? -
ANSWER: Her rapidly evolving clinical course indicates a poor prognosis
A 45-year-old African American man with no significant past medical history
presents with a 1-hour history of left retroorbital headache. It is described as
excruciating, stabbing, sharp, and lancinating; it is rated as severe in intensity. He
denies any preceding infections, nausea, vomiting, photophobia, or osmophobia; he
also denies fever, chills, stiff neck, focal weakness, numbness, tingling, vision,
hearing, gait, or speech changes. He recalls a similar episode several months ago; it
lasted about a week, and it dissipated without complications. His physical exam is
remarkable for painful distress, lacrimation with conjunctival injection, nasal
congestion, rhinorrhea, left ocular miosis, and left forehead diaphoretic flushing.
What pharmacologic agent is the most beneficial for this patient at this time? -
ANSWER: Sumatriptan
A 48-year-old woman presents after a seizure. Prior to the seizure, she experienced
confusion and disorientation preceded by nausea, vomiting, and blurred vision.
Symptoms appeared after working for several hours in the garden under the sun.
Her medical history is significant for the presence of schizophrenia, for which she
takes chlorpromazine at bedtime. Her temperature is 41 C; BUN and creatinine are
elevated; and there is neutrophilia, hemoconcentration, and lactic acidosis. You
