Block 13 Pace 2 Prt 1

The given patient presents with rapidly ascending weakness in her extremities, absence of deep tendon reflexes, increased CSF protein, and inflammation and demyelination in a peripheral nerve biopsy. These findings are consistent with Guillain-Barre syndrome, an autoimmune disorder characterized by inflammation and demyelination of peripheral nerves. The history of a recent viral respiratory tract infection further supports this diagnosis, as Guillain-Barre syndrome is often preceded by an infection. Myasthenia gravis is characterized by muscle weakness and fatigue, but it does not typically present with absent deep tendon reflexes or CSF abnormalities. Syringomyelia, Charcot-Marie-Tooth disease, and metabolic neuropathy do not fit with the clinical findings described.

Wallerian degeneration is the process of degeneration and disintegration of the axons of nerve cells that occurs when the nerve fiber is severed or damaged. In the case of a severe traumatic brain injury, diffuse axonal injury is a common occurrence where there is widespread damage to the axons throughout the brain. This is likely the reason for the occurrence of Wallerian degeneration in this woman's brain.

The patient's symptoms of weakness in the right upper extremity, non-fluent speech, poor repetition, and word-finding difficulty are indicative of a stroke affecting the middle cerebral artery distribution. The fact that the patient has an anterior (Broca's type) aphasia further supports this diagnosis. Additionally, the patient's history of uncontrolled hypertension and diabetes increases the likelihood of a stroke. The other options, such as anterior cerebral artery distribution stroke, hemorrhagic stroke, lacunar stroke, and border-zone stroke, do not align with the patient's symptoms and risk factors.

The symptoms presented by the patient, including tremors, hyperreflexia, tachycardia, mydriasis, increased bowel sounds, gait difficulties, and delirium, are consistent with serotonin syndrome. Serotonin syndrome is a potentially life-threatening condition that occurs due to an excess of serotonin in the body. The patient's history of depression, anxiety, and opiate dependence, as well as the medications she is currently taking (fluoxetine, olanzapine, and methadone), all contribute to an increased risk of developing serotonin syndrome. Benzodiazepine overdose, alcohol overdose, GABA syndrome, and opiate overdose do not fully explain the range of symptoms seen in this patient.

Mr. Davies is experiencing severe unilateral headaches that last for a week or so and then disappear until the next time. These headaches are accompanied by symptoms such as a stuffy nose, drooping eyelid, and flushed face. These symptoms are characteristic of cluster headaches, which are recurring headaches that occur in clusters or cycles. This is the most likely diagnosis based on the symptoms described.

The patient's doctor mentions that Drug X is safer than some of the others in pregnancy. This suggests that Drug X has been proven to have a lower risk of harm to the fetus compared to other antiepileptic drugs. Among the options given, carbamazepine is known to be relatively safe during pregnancy and is commonly used to treat seizures. Therefore, the correct answer is Drug X is carbamazepine.

Metastatic brain tumors occur when cancer cells from a primary tumor in another part of the body spread to the brain. The answer "lung, breast, melanoma" is the best choice because these three types of cancer are known to frequently metastasize to the brain. Lung cancer is the most common cause of brain metastases, followed by breast cancer and melanoma. Therefore, these primary malignancies account for the majority of metastatic brain tumors.

Plaques and tangles are the most characteristic pathological features of Alzheimer's disease, which is associated with progressive memory difficulties and cognitive decline. These plaques are made up of beta-amyloid protein and tangles are formed by twisted tau protein fibers. The presence of plaques and tangles in the brain is a definitive diagnostic feature of Alzheimer's disease. The other options, such as abnormal Tau protein and abnormal APOE4, are also associated with Alzheimer's disease but are not as specific or characteristic as plaques and tangles. Frontal atrophy and cerebellar stroke are unrelated to the pathological features of Alzheimer's disease.

The pathologist would most likely order the GFAP (Glial fast acidic protein) stain to identify the cells of astrocytic origin. GFAP is a specific marker for astrocytes, which are a type of glial cell found in the central nervous system. By staining for GFAP, the pathologist can distinguish astrocytes from other cell types and confirm the presence of astrocytic cells in the tumor. This stain is commonly used in immunohistochemistry to identify specific cell types based on the expression of certain proteins.

The given description of the seizure indicates that the child is experiencing a generalized convulsive seizure. This type of seizure involves the muscles of the entire body and is characterized by intense muscle contractions followed by a series of contraction-relaxation cycles. The child's lack of awareness of her environment further supports the diagnosis of a generalized seizure, as opposed to a partial seizure which typically allows for some level of awareness.

After administration of nitrous oxide, the most likely effect that occurred is analgesia being very pronounced. Nitrous oxide is commonly used as an analgesic in medical procedures due to its ability to provide pain relief. It does not cause unconsciousness or significantly decrease blood pressure, and while it may cause some muscle relaxation, it is not described as "excellent." Nitrous oxide can also cause respiratory depression, but this effect is not mentioned in the question stem. Therefore, the most likely effect in this case is pronounced analgesia.

The 23-year-old female likely suffered from vascular syncope. Vascular syncope refers to a temporary loss of consciousness due to a sudden drop in blood pressure and reduced blood flow to the brain. The combination of physical exertion in the desert, standing in the sun for an extended period, and possibly dehydration likely contributed to her collapse. The fact that she recovered quickly and is behaving normally suggests that it was a temporary episode rather than a more severe condition like heat stroke.

The given scenario describes symptoms of obsessive-compulsive disorder (OCD), characterized by repetitive and time-consuming rituals. Sertraline is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat OCD, as it helps to increase serotonin levels in the brain, which can reduce obsessive thoughts and compulsive behaviors. Alprazolam is a benzodiazepine used for anxiety disorders, not specifically for OCD. Amphetamine is a stimulant and not indicated for OCD. Clozapine is an antipsychotic used for schizophrenia, not OCD. Imipramine is a tricyclic antidepressant that may be used for OCD but SSRIs like sertraline are generally preferred.

Based on the patient's symptoms of dysphoric mood, difficulty concentrating, sleep disturbance, appetite disturbance, back pain, headache, and fatigue, it is most likely that she is experiencing major depressive disorder. These symptoms are consistent with the criteria for major depressive disorder, which include a depressed mood, loss of interest or pleasure in activities, changes in appetite or weight, sleep disturbances, fatigue or loss of energy, difficulty concentrating, and physical symptoms such as back pain and headaches. The patient's history of type II diabetes may contribute to the development of the mood disorder, but it is not the primary cause.

The enteric nervous system is responsible for controlling the movement and function of the gastrointestinal tract, including the muscles in the bowel. In this case, the absence of the enteric nervous system is causing improper muscle movement in the bowel, leading to constipation and slow growth.

The best classification for the patient's symptoms at this time is Acute Anxiety Reaction. The patient is experiencing intense fear and physical symptoms such as racing heart, heavy perspiration, and changes in vision. These symptoms are consistent with an acute anxiety reaction, which is a temporary and intense reaction to a specific trigger, in this case, the recent strong earthquake. The symptoms have been ongoing for the past two weeks and do not seem to be improving or worsening. This suggests that the reaction is acute rather than a chronic disorder like Generalized Anxiety Disorder or Specific Phobia.

The most appropriate procedure to definitively identify the causative agent is to culture the CSF on blood agar and chocolate agar media. This allows for the growth and isolation of the organism present in the CSF. By observing the characteristics of the organism and performing further tests, such as a catalase test or a coagulase test, the specific causative agent can be identified. The other options, such as performing a latex agglutination test or culturing the CSF on mannitol salt agar medium, would not provide a definitive identification of the causative agent.

The most likely cause of a 40-year-old man with an acute right subdural hematoma suddenly developing right ptosis with a dilated pupil non-reactive to light is transtentorial hippocampal herniation. This condition occurs when there is increased pressure in the brain, causing the medial temporal lobe to herniate through the tentorial incisura. This can lead to compression of the oculomotor nerve, resulting in ptosis and dilation of the pupil. The other options, such as acute hydrocephalus, occipital lobe infarct, and laceration of pedunculi, are less likely to cause these specific findings.

The individual's behavior of stealing another patient's identity and lying about his marital status suggests a disregard for societal norms and a lack of empathy for others. These traits are consistent with Antisocial Personality Disorder, which is characterized by a pattern of deceit, manipulation, and disregard for the rights of others.

The patient's symptoms, including headaches, weight loss, excessive sleep, difficulty waking up, and loss of interest in life, suggest a possible diagnosis of depression. The physician recommends pharmacotherapy to increase the action of several monoamines, which are neurotransmitters involved in mood regulation. Venlafaxine is a first-line drug for depression that works by inhibiting the reuptake of both serotonin and norepinephrine, increasing their levels in the brain. This can help alleviate symptoms of depression and reverse stress-induced damage.

The patient's presentation is consistent with a deep space infection, specifically a brain abscess, which is supported by the presence of a ring-enhancing lesion on CT scan. The swelling along the right side of the jaw suggests an odontogenic source of infection. Bacteroides fragilis is a common anaerobic organism found in the oral cavity and is a common cause of brain abscesses. Viridans group streptococci are also commonly found in the oral cavity and can cause deep space infections. Therefore, it is likely that these organisms would be isolated from the pus submitted for culture.

In the long term, Panic Control Treatment is most effective for the patient's symptoms of intense sweating, hyperventilation, and racing pulse before a test. This suggests that the patient may be experiencing panic attacks specifically related to test anxiety. Panic Control Treatment focuses on teaching the patient strategies to manage and reduce panic symptoms, such as breathing exercises and cognitive restructuring. It is considered the most effective approach for long-term management of panic attacks.

The correct answer is sleep apnea. Sleep apnea is a condition characterized by pauses in breathing or shallow breathing during sleep, leading to poor sleep quality and excessive daytime sleepiness. In children, sleep apnea can manifest as hyperactivity and disruptive behavior during the day. Treating sleep apnea can improve sleep quality and resolve the behavioral problems without the need for stimulant medication or psychotherapy.

The presentation of an obtunded patient with midposition and non-reactive pupils suggests uncal herniation. Uncal herniation occurs when the uncus, a part of the temporal lobe, herniates through the tentorium cerebelli, causing compression on the oculomotor nerve. This compression leads to midposition pupils and impaired pupillary light reflex. The absence of head trauma and the presence of slow regular respirations also support the diagnosis of uncal herniation. Bilateral Horner's Syndrome, pontine hemorrhage, opiate overdose, and organophosphate poisoning may present with altered mental status, but they do not typically cause midposition pupils.

The patient's symptoms, such as weight gain, excessive alcohol use, lack of motivation, negative ruminations, and decreased productivity at work, along with a history of increased mood and overspending, suggest a diagnosis of bipolar disorder with a seasonal pattern, also known as seasonal affective disorder (SAD). Quetiapine is a commonly used medication for the treatment of bipolar disorder, including SAD. It helps stabilize mood and reduce symptoms of depression and mania. Therefore, quetiapine would be an appropriate pharmacotherapy choice for this patient.

The patient in this scenario experienced cerebral cytotoxic edema, which is characterized by swelling of brain cells due to an influx of water. This condition is most commonly associated with dilutional hyponatremia, which occurs when the concentration of sodium in the blood is diluted due to excessive fluid intake or retention. This dilution of sodium leads to an osmotic imbalance, causing water to enter the brain cells and leading to cytotoxic edema. The other options, such as brain herniation, expanding mass lesion, breakdown of the blood-brain barrier, or affecting mainly the gray matter, do not align with the given information and are not the most likely mechanism in this case.