Order Mental Status Change Assignment Help

Order Mental Status Change Assignment Help
Order Mental Status Change Assignment Help
1. A 10-year-old girl presents with subacute
mental status change and left arm weakness.
She had a viral illness 1 week ago. On examination she appears drowsy. She has a left
sided hemiparesis with bilateral nystagmus.
Fundoscopy reveals papilledema. There are
no skin rashes. MRI head FLAIR sequence
is shown. MRI spine showed a longitudinally
extensive transverse myelitis. Which one of
the following is most likely?
a. Multiple sclerosis
b. Acute disseminating encephalomyelitis
c. Neurosarcoidosis
d. Neuromyelitis optica
e. Systemic lupus erythematosus
f. Lyme disease
2. A 35-year-old female presents with three days
of increasing weakness in the right arm and
reduced visual acuity in the left eye. She
had a similar episode 2 years ago which she
recovered from completely. On examination,
she has weakness in wrist extension and finger
abduction in the left hand and visual acuity in
the left eye was measured at 6/24 with an associated reduction in color saturation. Blood
tests were unremarkable. Her MRI scan is
shown (Axial T1 with contrast and FLAIR).
Which one of the following options should
be used in acute management?
a. Commence high dose oral prednisone
and wean over a month
b. IV methylprednisolone
c. Natalizumab infusion
d. Interferon beta
e. Biopsy
Order Mental Status Change Assignment Help
3. A 43-year-old female presents with a second
episode of loss of sensation in her left anterior
thigh and right foot. This is her second episode
within the past 4 months. She had recently
reported an episode of left anterior shin numbness 1 year ago, when anMRI with gadolinium
8 NEUROLOGY AND STROKE 131
demonstrated “spots in her spinal cord” and
she was diagnosed with transverse myelitis.
Her past medical history also includes ulcerative colitis, diagnosed aged 27years old and primary sclerosing cholangitis. Routine bloods
are normal except for mild derangement of
liver function tests.Which one of the following
is most appropriate?
a. Interferon beta
b. Glatiramer acetate
c. Fingolimod
d. Natalizumab
e. Mitoxanthrone
4. A 43-year-old female presents with a 2 week
history of mild left arm weakness and headache. MRI was done at presentation (shown).
She was discharged on dexamethasone 2 mg
twice daily due to her focal neurology with a
plan for awake craniotomy and resection. An
image guidance scan is repeated one week later
but there is no longer any ring-enhancement.
Which one of the following is most likely?
a. Cerebral abscess
b. High grade tumor
c. Metastasis
d. Primary CNS lymphoma
e. Demyelination
5. A 31-year-old female suffered multiple cuts
and burns to both arms. On examination,
there is marked wasting of the brachioradialis
and the small muscles in both hands, with
reduced biceps and brachioradialis reflex.
She is weak in both arms, distally more than
proximally. Her lower limb and cranial nerve
examination is unremarkable. On testing
upper limb sensation, vibration and proprioception are intact but there appears to be
reduced pain and temperature sensation over
the C3/C4/C5 dermatomes. Which one of
the following is most likely?
a. Chiari malformation
b. Chronic inflammatory demyelinating
polyneuropathy
c. Guillain-Barré syndrome
d. Miller Fisher syndrome
e. Multiple sclerosis
6. A 64-year-old man presents with a sudden
onset severe headache while watching television, followed by confusion and a tonic-clonic seizure. Past medical history included
a 20-pack-year smoking history, hypertension, hypercholesterolemia and myocardial
infarction two years ago requiring stenting.
On examination, GCS M5V4E3 but was protecting his own airway. Pupils were equal and
reactive. The patient was spontaneously
moving all his limbs and had downgoing
plantar reflexes. Cardiovascular, respiratory
and abdominal examination was unremarkable. Initial observations were blood pressure
220/115 mmHg, heart rate 89 beat/min, O2
sats (15 l O2) 100%, Respiratory rate 19/
min, temperature 37.1°C. CT brain is normal and lumbar puncture shows WCC 3/
mm3
, RBC 3, protein 0.6 g/l, glucose
5.4 mmol/l, and no xanthochromia. MRI is
shown (FLAIR). Which one of the following
is most likely
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