Myelin Disorders
A 43-year-old man comes to the emergency department because of vision problems over the past 2 days. Neurologic examination reveals problems with speech, memory, and coordination. He is living with HIV and his CD4+ cell count is 24 cells/mm³, A three-dimensional fluid-attenuated inversion recovery MRI reveals hyperintense areas of demyelination. His symptoms rapidly worsen, and he dies 3 weeks after admission.
Which of the following pathogens is the most likely cause of death in this patient?
Cryptococcus neoformans, JC virus, Herpes simplex virus, Pneumocystis jirovecii, Toxoplasma gondii
JC virus
Mr. J is a 19 y/o man who is brought to the ER by his mother and a police officer,
both of whom want him involuntarily to the psychiatric hospital. His mother
reports that he is “out of control” and that he punched her, which is when she
called the police. She says she had $400 missing from her room and she suspects
that he stole it. She said he told her he was out all day looking for a job and his
friend told her he was in the mall hanging out with friends. Mr. J was arrested 1
year ago for stealing an employer’s car and he was arrested 5 years ago when he
was “out of control”. School records show problems with truancy, fights in
school, etc. and his mom wants him to get treatment so that he does not end up
in jail again. While she is talking, J says “shut your f&*^% mouth you old
b*&%$!” When security check him, they find your wallet in his pocket. Which
personality disorder does he most likely have?
a. Antisocial Personality Disorder
b. Avoidant Personality Disorder
c. Borderline personality Disorder
d. Dependent Personality Disorder
e. Schizoid Personality Disorder
a. Antisocial Personality Disorder
2) MS is more frequently diagnosed: (select the correct answer)
a) In populations living close to the equator
b) Postmenopausal women
c) Individuals in their 20s and 30s
c) Individuals in their 20s and 30s
Mr. V is a 42 y/o, single man, who works as a security guard who was referred by his employer who describes him as “efficient” and “very reliable.” Mr. V started having some difficulties at work when other security guards were employed to do his shift with him to provide higher security to the building. Mr. V says he liked his job before the others came. He lives alone and has no interest in having friends or a girlfriend. He wants to ask the company to move him to another building, so that he can work by himself. If they can’t do that he will look for another job. Which personality disorder does he most likely have?
a. Antisocial Personality Disorder
b. Avoidant Personality Disorder
c. Borderline personality Disorder
d. Dependent Personality Disorder
e. Schizoid Personality Disorder
e. Schizoid Personality Disorder
Based on the 2017 Diagnostic Criteria MS can be diagnosed in which of the following:
a) After a patient that had experienced 2 attacks consistent with MS
b) A symptomatic patient with normal MRIs
c) A patient with optic neuritis and 2 non-enhancing T2 lesions
a) After a patient that had experienced 2 attacks consistent with MS
Two attacks consistent with MS are sufficient for a diagnosis provided alternative diagnoses are ruled out. In most instances the diagnosis is further supported by MRI imaging. Additional testing would be required to arrive a diagnosis of MS in a patient with a normal brain MRI (b). A patient with optic neuritis and >2 lesions in characteristic locations is at high risk for MS but at current acute involvement of the optic nerve cannot serve to meet the dissemination in time requirement
A 72-year-old patient with a history of hypertension and NIDDM for 20 years presents with complaints of headaches for several months and “something just not right with my vision”. On confrontation visual field testing you note a left homonymous superior quadrantanopia. Localize the lesion.
Right temporal lobe, Meyer's loop
Ms. N is a 32 y /o woman who is in therapy for treatment of her anxiety. She made an emergency appointment with her therapist because she has been offered a promotion in her job, and she doesn’t know whether to accept the promotion or not. She asked her husband, who told her he does not care as long as it brings in enough money. The therapist mentions “pros” and “cons” that the promotion has (“pros” and “cons” as described by the patient herself). Despite this, she perseverates on asking “What should I do?” “What would you do if you were me?” On the day of the deadline to accept or decline the promotion, Ms. N does not show at her job because she cannot make a decision on whether she will “yes” or “no.” Which personality disorder does she most likely have?
a. Antisocial Personality Disorder
b. Avoidant Personality Disorder
c. Borderline personality Disorder
d. Dependent Personality Disorder
e. Schizoid Personality Disorder
d. Dependent Personality Disorder
A 36-year-old patient presents with amenorrhea and unexplained weight loss for several months. Recently her vision seems to be “off”. A pituitary adenoma is on your differential. What would be the most common visual field findings?
Bitemporal hemianopsia or superior bitemporal quadrantopia