You are in the ED and have been called to assist in the eval…
You are in the ED and have been called to assist in the evaluation of an elderly patient who fell earlier today. The CT shows a concave, crescent-shaped mass between the skull and the surface of the cerebral hemisphere. The mass has crossed the sagittal suture line posteriorly. Which of the following is most likely diagnosis?
Read DetailsA 60-year-old male patient presents to the ED complaining of…
A 60-year-old male patient presents to the ED complaining of a sudden, thunderclap headache that is described as the worst headache he has ever had. He also has nausea and vomiting, meningismus, and a decreased level of consciousness. A CT of the head is normal. What is the next best diagnostic test?
Read DetailsA 72-year-old male nursing home resident is brought to the E…
A 72-year-old male nursing home resident is brought to the ED by staff after being found increasingly confused over the past 18 hours. PMH: type 2 DM, CKD stage III, and a splenectomy about 20 years ago. His medications include metformin, lisinopril, and a daily aspirin. Vital signs – temp: 100.6°F, BP:102/58 mmHg, HR:108 bpm, and RR: 22 BPM.On exam, he is lethargic and oriented only to self. He has nuchal rigidity, but Kernig and Brudzinski signs are equivocal. There is no rash. LP performed with the following CSF analysis:Opening pressure: elevated Appearance: cloudy WBC: 2,200 cells/μL (92% neutrophils) Glucose: low Protein: elevated Gram stain: Gram-positive diplococci. Given this patient’s presentation, risk factors, and CSF findings, which of the following is the most likely diagnosis?
Read DetailsA 67-year-old right-handed male is brought to the ED by his…
A 67-year-old right-handed male is brought to the ED by his wife after she noticed he suddenly began struggling to speak during breakfast. She reports that when she asked him if he was okay, he appeared frustrated and replied, “I… want… the… thing…” while gesturing toward his coffee cup. He was able to follow her instructions to stand up, walk to the car, and buckle his seatbelt without difficulty. On exam, the patient is alert and appears to understand all questions and commands. When asked to describe what happened this morning, he speaks in short, effortful phrases with long pauses. He correctly points to objects in the room when asked and follows multi-step commands. However, when asked to name a pen, he says, “I write… the… it’s for…” and becomes visibly frustrated. Which of the following best characterizes this patient’s language deficit?
Read DetailsA 48-year-old female presents to her PCP with a 6-month hist…
A 48-year-old female presents to her PCP with a 6-month history of progressively worsening headaches and difficulty driving. She reports that she has been “side-swiping” objects on both sides while driving. She also notes that her menstrual periods stopped approximately 8 months ago, and she has noticed a milky nipple discharge bilaterally. Laboratory studies reveal an elevated serum prolactin level. MRI of the brain demonstrates a 2.8 cm sellar mass with suprasellar extension. Given the anatomic relationship between this mass and the surrounding structures, which visual field defect would be expected on exam?
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