Block 13 Pace 1 Prt 2

The most likely diagnosis in this case is Guillain-Barre syndrome. This is supported by the acute onset of ascending paralysis following a respiratory tract infection, which is a characteristic feature of Guillain-Barre syndrome. The marked slowing of nerve conduction velocity studies also aligns with this diagnosis. Additionally, the patient's eventual complete recovery of respiratory and motor functioning after receiving respiratory support, corticosteroids, and plasmaphoresis is consistent with the typical course of Guillain-Barre syndrome.

The patient's symptoms of chronic worrying, re-experiencing traumatic events, overreacting to loud noises, and trouble focusing in traffic situations are consistent with Post Traumatic Stress Disorder (PTSD). PTSD is a mental health condition that can develop after experiencing or witnessing a traumatic event. The patient's symptoms suggest that he is constantly reliving the traumatic event, experiencing hyperarousal, and having difficulty concentrating, which are common symptoms of PTSD.

The patient's symptoms of right-sided weakness of the arm more than the leg and difficulty with speech, specifically with repeating and finding the right words, are consistent with a middle cerebral artery distribution stroke. This type of stroke often affects the dominant hemisphere of the brain, leading to language deficits. The mention of "Broca's type" aphasia further supports this correlation, as Broca's area, located in the frontal lobe of the dominant hemisphere, is responsible for speech production. The patient's history of uncontrolled hypertension and diabetes also increases the likelihood of a stroke.

The mode of transmission of the causative agent, West Nile virus, is through the bite of an infected mosquito.

The most likely pathologic finding in this patient's brain is foci of demyelination. This is suggested by the relapsing and remitting episodes of neurologic deficits, gradual and partial remissions, mildly elevated protein level in the spinal fluid, and increased gamma globulin with oligoclonal banding. These findings are consistent with multiple sclerosis, which is characterized by the immune system attacking the myelin sheath in the central nervous system, leading to foci of demyelination.

Based on the symptoms described, the most accurate diagnosis for Mr. Davies' headache is cluster headaches. Cluster headaches are characterized by severe, unilateral pain, stuffy nose, drooping eyelid, and flushed face. The fact that Mr. Davies has experienced similar headaches in the past, which last for a short duration and occur periodically every few months, is also consistent with cluster headaches. Migraine with aura and complicated migraine can be ruled out because they typically last longer than half an hour. Trigeminal neuralgia usually presents with sharp, shooting facial pain, which is not mentioned in the description. Muscle tension headache does not account for the specific symptoms mentioned.

The patient's presentation is consistent with bacterial meningitis, as evidenced by the fever, headache, stiff neck, mild confusion, positive Kernig and Brudzinski signs, and abnormal CSF findings. The most common causative agent of bacterial meningitis in adults is Streptococcus pneumoniae, which is also known as pneumococcus. This bacterium commonly colonizes the nasopharynx and can cause invasive infections, such as meningitis, when it gains access to the bloodstream. The CSF findings of a leukocytic pleocytosis with predominantly neutrophils, low glucose, and elevated protein are typical of bacterial meningitis, and Streptococcus pneumoniae is the most common cause of this type of meningitis in adults.

The most likely cause of the patient's neurological abnormality is the rupture of a berry aneurysm. This is indicated by the sudden onset of a severe headache followed by coma and death, which are consistent with subarachnoid hemorrhage. Berry aneurysms are the most common cause of subarachnoid hemorrhage, and they typically occur in individuals with a history of systemic hypertension. The other options, such as Charcot-Bouchard aneurysm, anthrax, mycotic aneurysm, and Kaposi sarcoma metastasizing to the subarachnoid space, are less likely based on the given information.

The basis for the physician's presumptive diagnosis is the patient's history of focusing problems when he was six years old. This suggests that the patient has had long-standing difficulties with attention and concentration, which is consistent with a diagnosis of Attention Deficit Hyperactive Disorder, Inattentive type. The other options, such as history of poor concentration, history of easy distractibility, poor performance on the verbal component of the MCAT, and history of poor attention in class, are also indicative of attention difficulties but do not provide as strong of a basis for the diagnosis as the patient's history of focusing problems at a young age.

The correct answer is to treat the underlying problem. In this case, the patient's symptoms of agitation, diaphoresis, tachycardia, and inappropriate behavior are likely due to a complication or side effect of the surgery. By addressing and treating the underlying issue, such as an infection or adverse reaction to medication, the patient's symptoms should improve. Treating each symptom individually or avoiding treatment altogether would not address the root cause of the problem.

Plaques and tangles are the most likely pathological findings to confirm the clinical diagnosis in this case. Plaques are abnormal clusters of beta-amyloid protein that accumulate between nerve cells in the brain, while tangles are twisted fibers of tau protein that build up inside cells. These are characteristic features of Alzheimer's disease, which is a common cause of memory difficulties and cognitive decline in older individuals. The gradually progressive nature of the memory difficulties over 8 years, along with the unrevealing workup, further support the likelihood of Alzheimer's disease as the diagnosis.

The most likely diagnosis in this case is pilocytic astrocytoma. This is suggested by the presentation of the patient with headaches, nausea, and vomiting, as well as the findings on the MRI scan which show hydrocephalus and a posterior fossa mass. Pilocytic astrocytoma is a type of brain tumor that commonly occurs in children and is often located in the posterior fossa. The gross and microscopic appearance of the lesion shown in the question is consistent with pilocytic astrocytoma.

Based on the reported symptoms, the best DSM IV classification at this time would be Acute Stress Reaction. The patient is experiencing intense fear and avoidance behaviors following a recent strong earthquake, which is a traumatic event. She also describes feeling emotionally numb and detached from herself, which are common symptoms of acute stress reaction. Additionally, her symptoms have been present for the last two weeks and have not improved or worsened during that time, which is consistent with the time frame for acute stress reaction.

The most likely explanation for the woman's collapse and passing out is vascular syncope. Vascular syncope, also known as a fainting episode, is often triggered by a sudden drop in blood pressure, which can occur after prolonged standing, heat exposure, or physical exertion. In this case, the combination of military maneuvers in the desert, standing at attention in the sun, and possibly dehydration or fatigue could have caused her blood pressure to drop suddenly, leading to her collapse. Her quick recovery and normal behavior afterward further support this explanation.

The correct answer is "relentless progression to death, usually from secondary infection." In severe hemophilia A, the development of symptoms of widespread cerebral inflammation suggests the presence of a severe complication called intracranial hemorrhage. The microglial nodules and abnormal cells seen on biopsy indicate an inflammatory response in the brain. Without treatment, the intracranial hemorrhage and cerebral inflammation will continue to progress, leading to worsening neurological symptoms and ultimately death, often due to secondary infection.

The patient's symptoms of dysphoric mood, difficulty concentrating, sleep disturbance, appetite disturbance, back pain, headache, and fatigue are consistent with the diagnostic criteria for major depressive disorder. Major depressive disorder is characterized by a persistent feeling of sadness or loss of interest in activities, along with other symptoms such as changes in appetite and sleep patterns, fatigue, and difficulty concentrating. This diagnosis is the most likely type of mood disorder exhibited by the patient based on her symptoms and history of type II diabetes.

Concept: Clinical presentation of upper brain stem tumors in children PaCE