A 30-year-old male presented with vertigo and deafness in the left ear. His trunk was examined which revealed multiple coffee colored patches of 2-3 cm of variable shapes.
On neurological examination, the patient may had an absent left sided corneal reflex and ipsilateral cerebellar signs.
He had an audiogram as part of the investigation for his symptoms. There is severe hearing loss at progressively higher frequencies in the left ear. There was no air–bone gap in Audiogram.
What is the most likely diagnosis?
A. Tuberous sclerosis
B. Neurofibromatosis type 1
C. Neurofibromatosis type 2
D. Sturge Weber syndrome
E. Meningioma
Massive increase in transaminases ( AST and ALT ) with modest increase in bilirubin and alkaline phosphatase most likely diagnosis will be ?
A.Alcholic hepatitis
B.acute hepatitis
C.ischemic hepatitis
D.acalculous cholecystitis
A 57 years old women is refferd to urogynaecology wid symptoms of urge incontinence a trial of bladder retaining is unsuccessful it z therefore decided to use an muscarinic antagonist which one of the following medications is an example of a muscarinic antagonists?
A tolterodine
B Teriparatide
C Toremifene
D Finasteride
E Tamsuline
A 65-year-old retired school teacher presented with a six-month history of progressive weakness, fatigue and breathlessness which was accompanied by weight loss of 5 kg. He had difficulty climbing stairs because his ‘legs would not carry him’, and had noticed that he had difficulty holding light objects with his left hand without dropping them. Over the past week his wife had noticed that his speech appeared slurred and nasal, and he was having difficulty swallowing his meals. He had a past history of pernicious anaemia for which he was taking regular intramuscular B12 injections.
On examination, he was thin. There was no evidence of pallor or clubbing.The patient had dysarthria. Examination of the cranial nerves revealed normal eye movements, but tongue movement was sluggish and there was reduced palatal movement. The jaw jerk was brisk. On examination of his limbs there was wasting and fasciculation of the smallmuscles of the left hand. The tone and power in the left upper limb was generally reduced. The upper limb reflexes were brisk. There was wasting and fasciculation inboth thigh muscles. The tone was increased and the power was reduced. The ankle and knee jerks were brisk, and there was obvious clonus at the ankle joint. Sensation was normal and Romberg’s test was negative. Examination of the fundi revealed bitemporal pallor. Investigations are shown.
Hb 12 g/dl, WCC 5×10^9/l, Platelet 180×10^9/l, MCV 86 fl
Sodium 137 mmol/l, Potassium 4.1 mmol/l
Urea 6 mmol/l, Creatinine 110 μmol/l
Chest X-ray Normal.
What is the diagnosis?
a. Cervical myelopathy.
b. Subacute combined degeneration of the spinal cord.
c. Multiple sclerosis.
d. Motor neurone disease.
e. Polymyositis.
A 17-year-old girl is brought into resus in cardiac arrest. On admission she is in asystole and attempts to
resuscitate are unsuccessful. She collapsed whilst competing in a 1,500m race at college. The only past
medical of note was asthma for which she occasionally used a salbutamol inhaler. There is no relevant family
history. What is the most likely underlying cause of death?
A. Long QT syndrome
B. Hypertrophie obstructive cardiomyopathy
C. Catecholaminergic polymorphic ventricular tachycardia
D. Brugada syndrome
E. Arrhythmogenic right ventricular dysplasia