EMQs in Clinical Medicine.pdf - Peshawar Medical College

Neurological problems 81
35 Neurological problems
A
B
C
D
E
F
muscular dystrophy
Shy–Drager syndrome
chronic fatigue syndrome
neurofibromatosis
myasthenia gravis
melanoma
G
H
I
J
K
Sturge–Weber syndrome
syringomyelia
pseudobulbar palsy
Bell’s palsy
cervical spondylisthesis
For each clinical scenario below, give the most likely cause for the clinical findings.
Each option may be used only once.
1 A 45-year-old woman complains of a pain behind the right ear and that her
mouth is sagging on the right-hand side.
2 A 62-year-old woman presents with a stiff spastic tongue and ‘Donald Duck’-
like speech. On examination she had a brisk jaw jerk and was prone to laughing
inappropriately.
3 A 27-year-old woman presents with wasting and weakness of the small muscles
of the hand. Examination reveals loss of pain and temperature sensation over
the trunk and arms with intact vibration sense.
4 A 34-year-old woman complains of generalized weakness in her muscles,
diplopia and weakening of her voice if talking for longer than 30 s. Examination
reveals bilateral ptosis.
5 A 15-year-old boy is found to have several coffee-coloured patches on his body.
Slit-lamp examination reveals the presence of Lisch nodules.
Answers: see page 96.