Day 13
Diagnose the case, Give the investigations, suggest the management and select the rubrics

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1.  A post-menopausal female presents with progressive incoordination. Physical examination is remarkable for nystagmus, mild dysarthria, and past-pointing on finger-to-nose testing. She also has an unsteady gait. MRI reveals atrophy of both lobes of the cerebellum. Serologic evaluation reveals the presence of anti-Yo antibody. Which of the following is the most likely cause of this clinical syndrome? A. Non-small cell cancer of the lung B. Small-cell cancer of the lung C. Breast cancer D. Non-Hodgkin’s lymphoma E. Colon cancer. Explain your answer, give related rubrics
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2.  A young female is evaluated in an outpatient clinic for a complaint of amenorrhea. She reports that she feels as if she never developed normally compared with other girls her age. She has never had a menstrual period and complains that she has had only minimal breast growth. Past medical history is significant for a diagnosis of borderline hypertension. In childhood the patient frequently had otitis media and varicella infections. She received the standard vaccinations. She recently graduated from high school and has no learning difficulties. She is on no medications. On physical examination, the patient is of short stature with a height of 56 in. Blood pressure is 142/88. The posterior hairline is low. The nipples appear widely spaced, with only breast buds present. The patient has minimal escutcheon consistent with Tanner stage 2 development. Her external genitalia appear normal. Bi- manual vaginal examination reveals an anteverted uterus. The ovaries are not palpable. What is the most likely diagnosis? A. HypothyroidismB. Hyperthyroidism C. Malnutrition D. Testicular feminization E. Turner syndrome (gonadal dysgenesis)
. Justify your answer, give related rubrics.
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3.   A young healthy woman visits your office during the fifth month of pregnancy. Her blood pressure is 142/86 mmHg. What should be your next step in management? A. Have her return to your clinic in 2 weeks for a blood pressure check B. Initiate an angiotensin-converting enzyme inhibitor C. Initiate an antihypertensive D. Recheck her blood pressure in the seated position in 6h E. Recheck her blood pressure in the lateral recumbent position in 6 h. Explain why? Give rubrics
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4.  A patient with a narrow-based gait instability complains that he needs to look at his feet while he walks to prevent falling. He feels wobbly standing with his eyes closed and notes frequent falls. On examination, he has no difficulty initiating gait, his stride is regular, strength is normal, and there is no tremor. Review of routine blood work drawn 3 months prior reveals a hematocrit of 29% with an elevated mean corpuscular volume. Which of the following is the most likely diagnosis? A. Amyotrophic lateral sclerosis B. Cerebellar tumor C. Cerebrovascular disease D. Parkinson’s disease E. Pernicious anemia. Justify your answer. What are the related rubrics.
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5.   A young woman presents with acute vision loss and pain in the left eye, but no other symptoms. On examination she appears well, visual acuity is not possible, and she can only perceive movement and bright light. The direct papillary reflex is absent but the indirect (con- sensual) response is normal. The optic disc is edematous. Which of the following symptoms is also most likely present in patients with this condition? Explain
(A) limb weakness (B) hemiplegia 
(C) cervical myelopathy (D) sphincter impairment (E) seizures 
. Why? Give specific rubrics if any?
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