Chief Complaint: A 28-year-old woman presents to the clinic with complaints of intermittent blurry vision and weakness in her right leg over the past few weeks. History of Present Illness: The patient reports that about a month ago, she experienced pain and decreased vision in her left eye, which gradually improved over two weeks. More recently, she has noticed a tingling sensation in her right leg, which progressed to mild weakness, making it difficult for her to walk long distances. She also reports episodes of fatigue and occasional difficulty controlling her bladder. She denies any fever, recent infections, or trauma. Past Medical History: No known chronic illnesses No prior neurological conditions No family history of similar symptoms Review of Systems: Neurologic: Numbness, weakness in the right leg, occasional imbalance Ophthalmologic: Blurry vision in the left eye, previously painful eye movements Genitourinary: Episodes of urinary urgency Physical Examination: Vital Signs: Normal Neurologic Exam: Decreased visual acuity in the left eye, relative afferent pupillary defect (RAPD) Hyperreflexia in the right leg Positive Lhermitte’s sign (electric shock-like sensation down the spine when flexing the neck) Mild difficulty with tandem gait Diagnostic Workup: MRI Brain and Spine: Multiple periventricular and spinal white matter lesions with contrast enhancement (suggestive of active demyelination). Lumbar Puncture (CSF Analysis): Presence of oligoclonal bands and increased IgG index. Visual Evoked Potentials (VEPs): Delayed response in the left optic nerve. What is the most likely diagnosis?
A 35-year-old woman presents to the clinic with complaints of drooping eyelids and double vision that worsens toward the end of the day. She also reports difficulty chewing and occasional slurred speech. On examination, her ptosis improves briefly after applying an ice pack to her eyelids. Which of the following is the most likely diagnosis?
A 45-year-old individual diagnosed with Myasthenia Gravis (MG) undergoes a routine chest CT scan, which reveals the presence of a thymoma. The patient has been experiencing fluctuating muscle weakness, characteristic of MG, and has been managing the condition with acetylcholinesterase inhibitors and immunosuppressive therapy. Given the new finding of a thymoma, the healthcare team discusses potential treatment options, including surgical intervention. Question: Which of the following statements about thymectomy in this scenario is most accurate?
A 36 year-old male comes to your office with a gait disorder. His medical history is significant for HIV for six years. In patients infected with HIV, which of the following is an AIDS-defining illness?
A 7-year-old boy is brought to the emergency department with confusion, vomiting, and lethargy. His symptoms started a few days after recovering from a viral illness, during which he was given aspirin for fever. On examination, he is drowsy but arousable. Laboratory tests reveal markedly elevated ammonia levels, hypoglycemia, and mild elevations in liver enzymes. There is no significant leukocytosis, and bilirubin levels are normal. Which of the following is the most likely diagnosis?
A 30-year-old man presents with fever, myalgia, and a maculopapular rash that started on his palms and soles. He recently returned from a hiking trip in Oklahoma. Laboratory tests reveal hyponatremia and elevated liver enzymes. A skin biopsy of the rash shows vasculitis. Question: Which of the following is the most likely complication if this patient’s condition is left untreated?
A 50-year-old man presents with fever, confusion, and hypotension one week after a camping trip. His family reports that he had a rash starting on his wrists and ankles, but it has now become purpuric and widespread. Lab tests show thrombocytopenia, hyponatremia, and elevated liver enzymes. Despite treatment, his condition worsens, and he develops renal failure and respiratory distress. Which of the following is the most likely cause of his worsening condition?
Patient Case: A 50-year-old man presents with fever, malaise, and a rash on his extremities after a hunting trip in Oklahoma. Labs show thrombocytopenia and elevated liver enzymes. Suspecting Rocky Mountain Spotted Fever, you consider treatment options given his worsening condition. What is the most appropriate initial treatment for Rocky Mountain Spotted Fever in this patient?
A 42-year-old male hiker returns from a camping trip in North Carolina and presents with fever, severe headache, and muscle aches. He reports that he removed a tick from his leg about 5 days ago. On examination, you note a maculopapular rash on his wrists and ankles, which has started spreading centrally. He also complains of nausea and abdominal pain. Which of the following clinical features is most characteristic of Rocky Mountain Spotted Fever (RMSF)?
A 35-year-old woman presents with a 4-day history of fever, chills, and severe headache. She reports a recent hiking trip in Tennessee. On day 4, you observe a petechial rash starting on her wrists and ankles spreading to her palms, soles, and trunk. She denies joint pain or a bullseye rash. Which of the following best describes the typical progression of the rash in Rocky Mountain Spotted Fever?
