A 24 year-old male comes to your office for some laboratory tests prescribed by his infectious diseases specialist. He started on isoniazid as part of his treatment for latent tuberculosis 6 weeks ago. Patient reports he has been taking isoniazid as prescribed. He does not report any symptoms today. His physical examination is unremarkable. The laboratory test results include the following: Serum Reference Range Alanine aminotransferase (ALT) 88 U/L 10 – 40 U/L Aspartate aminotransferase (AST) 96 U/L 12 – 38 U/L Alkaline phosphatase 104 U/L 25 – 100 U/L What is the next best step in the management of this patient?
A 20 year-old female comes to your office to learn about isoniazid because she came positive for a recent PPD test after sharing her apartment with a relative who has active tuberculosis. Of the following, which is a true statement regarding isoniazid?
A 32 year-old male comes to your ophthalmology clinic complaining of increasingly blurry vision and headaches. His wife reports that his gait became clumsy, his speech became slurred. On review of systems, you discover that he has difficulty swallowing, and having frequent headaches. Patient reports that some of his relatives also have similar medical problems. On physical examination, you notice a sweaty, anxious looking male. Cardiac exam is significant for palpitations. In retinal exam, you find dilation and tortuosity of retinal vessels, angiomatous lesions with hemorrhages and exudates in both eyes. Suspecting a systemic disorder, you order some investigative studies, which reveal hemangioblastomas in the cerebellum, two nodules in the pancreas and a large tumor in the kidney. The lesions have a striking appearance of a cyst with a nodule contained in its wall, and angiography demonstrates the highly vascular nature of the nodules. The laboratory tests reveal elevated plasma free fractionated metanephrines, and elevated white blood cells, red blood cells and platelets. Of the following, which is the most likely diagnosis in this patient?
Thomas is a 22 year-old college student who sustained a head injury 3 weeks ago while playing golf. He did not suffer loss of consciousness but later that day developed headache, dizziness, insomnia, blurred vision, restlessness and inability to concentrate. He has a prior history of anxiety and depression. His neurological examination is normal and the MRI scan of his head done a week ago is unremarkable. Thomas reports that his symptoms ‘somewhat improved’ but not completely. Which of the following have a role in the management of his disorder?
Which of the following neurotransmitters and enzymes are markedly reduced in the basal ganglia of patients with Huntington disease?
A 42 year-old caucasian male presents to your office for the evaluation of his loss of fine manual skills, diminished work performance, inability to manage household responsibilities and disturbances of sleep. For the last 10 months, he has been experiencing repeated, irregular movements of his eyebrows and the muscles in his forehead. His hands and legs feel rigid. He has developed uncontrolled jerking movements of face, arms, and trunk, which he cannot control. He has trouble speaking. He developed loss of balance and had trouble walking. He hears, sees, smells and feels things that others do not. He is having problems with his memory. He is becoming increasingly suspicious of others, even his wife. He is having difficulty figuring out where he is, what time, date or day it is. He is no more interested in doing things he used to enjoy. He reports some of his relatives in his extended family also developed similar symptoms around his age. You ordered some laboratory work up and genetic testing. His head CT showed cerebral and caudate nucleus atrophy. Genetic testing revealed CAG trinucleotides with defective genes localized on chromosome 4. Of the following, what is the most likely diagnosis in this patient?
A 68 year-old female is having pronounced problems with his memory compared to adults in her age group. She has no functional impairment. Her neurologist diagnosed her with Mild Cognitive Impairment. Which of the following disorders is the most common complication in individuals with mild cognitive impairment?
A 64 year-old female, Mrs.Jane, comes to your office for her annual health checkup. For the last few months, she has been having difficulty remembering the names of her friends. She struggles to remember even the names of some of her grandchildren. Sometimes she struggles to find the right words to express her thoughts. Sometimes she wonders whether she has taken her regular blood pressure medication even after she took it. Two weeks ago, her niece called her to attend her birthday party over the weekend, but after two days, she completely forgot about it. She was planning to go to Orlando, Florida for a business conference. She was able to register to attend the conference, was able to buy the plane tickets but forgot to book a hotel room. Until recently, she used to do these things so systematically and effortlessly. She is sleeping well, feeling good about herself and her financial situation. There is no change in sexual life. Her family members have not noticed anything different in her but she feels that ‘something is not right with my memory and planning’. Noone complained about her behavior – no impulsivity, no aggressiveness, no inappropriate conversations. She is still able to take care of herself. She reports that she is able to cook, drive, go to work, go to gym, do gardening and work on her computer. There is no change in her performance at house and work. Her vital signs are normal. As you observe her, you see a well-dressed, well behaved individual. Her physical examination including nervous system is normal. Of the following, which is the most likely explanation for this patient’s symptoms and signs?
A 47-year old male is brought to your office by his wife for psychological evaluation. She reports that for the last 6 months, she has been noticing changes in her husband’s personality, behavior and speech. There is a gradual decline in his memory. He has become more suspicious of her, washing hands repeatedly, checking the doors and windows more than usual. He is struggling to find the right words to express himself. He is undressing in public places and cracking inappropriate jokes. In the last month, he had fallen several times, become incontinent of urine, and had difficulties with basic activities of daily living such as brushing his teeth and dressing. He developed a voracious appetite, eating 4-5 pieces of cheesecake at a time. A magnetic resonance imaging scan of the brain demonstrated enlarged sulci and ventricles and cortical and white matter atrophy of the frontal lobes and temporal lobes. What is the pathological hallmark of this disorder?
