Day 24
Diagnose the case, Give the investigations, suggest the management and select the rubrics

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1. A 51-year-old male presents to your clinic complaining of lower back pain. When he exerts himself or lifts items, he describes worsening of the pain and also pain in the left buttock that radiates down the posterior left thigh. The patient denies pain at rest and any history of trauma. You examine his lower back. Which examination maneuver is the most specific for lumbar disk herniation? A. Right straight leg raise B. Left straight leg raise C. Right crossed straight leg raise D. Left crossed straight leg raise E. Reverse straight leg raise
. Explain
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2. A 46-year-old woman presents to your clinic with multiple complaints. She describes fatigue and general malaise over 2–3 months. Her appetite has decreased. She thinks she has unintentionally lost ~5.5 kg. Lately she notes pain and stiffness in her fingers on both hands that is worse in the morning and with repetitive movement. She has a grandmother and a sister who have rheumatoid arthritis (RA), and she is very concerned that she now has it as well. Which of her complaints represents the most common manifestation of established RA? A. Fatigue and anorexia for >2 months with concomitant joint pain B. Morning joint stiffness lasting for >1 h C. Pain in symmetric joints worsened with movement D. Positive family history with two relatives with RA E. Weight loss >4.5 kg during period of active disease
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3. Which of the following cranial nerve physical examination techniques represents the correct approach to the patient with suspected neurologic disease? A. Olfactory nerve: With eyes closed, ask the patient to sniff a pungent stimulus such as ammonia or alcohol. B. Optic nerve: Check visual acuity in both eyes using a Snellen chart without having the patient use their corrective lenses. C. Trigeminal nerve: Examine the motor territories on each side of the face by testing jaw clench, eyebrow elevation, and forehead wrinkling. D. Accessory nerve: Check shoulder shrug and head rotation on each side against resistance
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4.  A 45-year-old male presents with a daily headache. He describes two attacks per day over the last 3 weeks. Each attack lasts about an hour and awakens the patient from sleep. The patient has noted associated tearing and reddening of the right eye as well as nasal stuffiness. The pain is deep, excruciating, and limited to the right side of the head. The neurologic examination is nonfocal. The most likely diagnosis of this patient’s headache is A. migraine headache B. cluster headache C. tension headache D. brain tumor E. giant cell arteritis Explain
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5. A 72-year-old female presents with brief, intermittent excruciating episodes of lancinating pain in the lips, gums, and cheek. These intense spasms of pain may be initiated by touching the lips or moving the tongue. The results of a physical examination are normal. MRI of the head is also normal. The most likely cause of this patient’s pain is A. acoustic neuromaB. meningioma C. temporal lobe epilepsy D. trigeminal neuralgia E. facial nerve palsy Justify your answer
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