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A 76 years old white woman is brought in by her children because she is becoming more forgetful. She used to pay her bills independently and enjoyed cooking but has recently received overdue notices from utility companies and finds it difficult to prepare a balanced meal. She has lost 3.5 kg in the past 3 months, and left the water running in her bathtub and flooded the bathroom. When her children express their concerns, she becomes irritable and resists their help. Her house has become more cluttered and unkempt. Physical exam and laboratory analysis are unremarkable. The current evaluation reveals no depressive symptoms and 2/15 on the Geriatric Depression Scale short-form. Her Mini-Mental State Examination (MMSE) score is 20/30. What potential sequelae do you need to be concerned about?

December 27, 2020 6:57 am Published by

Substance abuse, depression and suicide

A 76 years old white woman is brought in by her children because she is becoming more forgetful. She used to pay her bills independently and enjoyed cooking but has recently received overdue notices from utility companies and finds it difficult to prepare a balanced meal. She has lost 3.5 kg in the past 3 months, and left the water running in her bathtub and flooded the bathroom. When her children express their concerns, she becomes irritable and resists their help. Her house has become more cluttered and unkempt. Physical exam and laboratory analysis are unremarkable. The current evaluation reveals no depressive symptoms and 2/15 on the Geriatric Depression Scale short-form. Her Mini-Mental State Examination (MMSE) score is 20/30. What are the most important differential diagnoses?

December 27, 2020 6:56 am Published by

Of the relevant differential diagnoses, it is important to rule out brain tumor, cerebrovascular insufficiency and substance abuse (intoxication or... View Article

A 76 years old white woman is brought in by her children because she is becoming more forgetful. She used to pay her bills independently and enjoyed cooking but has recently received overdue notices from utility companies and finds it difficult to prepare a balanced meal. She has lost 3.5 kg in the past 3 months, and left the water running in her bathtub and flooded the bathroom. When her children express their concerns, she becomes irritable and resists their help. Her house has become more cluttered and unkempt. Physical exam and laboratory analysis are unremarkable. The current evaluation reveals no depressive symptoms and 2/15 on the Geriatric Depression Scale short-form. Her Mini-Mental State Examination (MMSE) score is 20/30. What is the most likely diagnosis?

December 27, 2020 6:53 am Published by

Alzheimer’s disease

A 44 years old male smoker presents with a 9-year history of current headaches occurred twice-monthly, always in the early hours of the morning. The headaches have increased to an average of 2 episodes per day. The acute episodes can occur at any time, and last between 2 and 4 hours. He always has a nocturnal event. Attacks are triggered immediately after drinking alcohol or with strong smells. The pain is excruciating and focused around his right eye. He becomes severely agitated during attacks, often pacing the room or rocking back and forth. On examination, his right eye is reddened with lacrimation and drooping of the eyelid, and right-sided rhinorrhea. What potential sequelae do you need to be concerned about?

December 27, 2020 6:52 am Published by

Depression, increased suicide risk and impaired social and occupational functioning

A 44 years old male smoker presents with a 9-year history of current headaches occurred twice-monthly, always in the early hours of the morning. The headaches have increased to an average of 2 episodes per day. The acute episodes can occur at any time, and last between 2 and 4 hours. He always has a nocturnal event. Attacks are triggered immediately after drinking alcohol or with strong smells. The pain is excruciating and focused around his right eye. He becomes severely agitated during attacks, often pacing the room or rocking back and forth. On examination, his right eye is reddened with lacrimation and drooping of the eyelid, and right-sided rhinorrhea. What are the most important differential diagnoses?

December 27, 2020 6:52 am Published by

Of the relevant differential diagnoses, it is important to rule out pituitary or brain tumor, increased intracranial pressure, meningeal irritation,... View Article

A 44 years old male smoker presents with a 9-year history of current headaches occurred twice-monthly, always in the early hours of the morning. The headaches have increased to an average of 2 episodes per day. The acute episodes can occur at any time, and last between 2 and 4 hours. He always has a nocturnal event. Attacks are triggered immediately after drinking alcohol or with strong smells. The pain is excruciating and focused around his right eye. He becomes severely agitated during attacks, often pacing the room or rocking back and forth. On examination, his right eye is reddened with lacrimation and drooping of the eyelid, and right-sided rhinorrhea. What is the most likely diagnosis?

December 27, 2020 6:51 am Published by

Cluster headaches

A 45 years old man presents with loss of libido and some erectile dysfunction. He is otherwise healthy. On physical examination he has mild bilateral gynecomastia and normal testes. Laboratory work-up reveals a highly elevated prolactin level and low testosterone and gonadotropin (LH, FSH) levels. Visual field assessment reveals bitemporal hemianopia. What potential sequelae do you need to be concerned about?

December 27, 2020 6:50 am Published by

Visual impairments, hypopituitarism, pituitary apoplexy and osteoporosis

A 45 years old man presents with loss of libido and some erectile dysfunction. He is otherwise healthy. On physical examination he has mild bilateral gynecomastia and normal testes. Laboratory work-up reveals a highly elevated prolactin level and low testosterone and gonadotropin (LH, FSH) levels. Visual field assessment reveals bitemporal hemianopia. What are the most important differential diagnoses?

December 27, 2020 6:49 am Published by

Of the relevant differential diagnoses, it is important to consider hypothyroidism, pituitary adenomas and polycystic ovarian disease.

A middle-aged woman presents with a complaint of frequent, brief episodes of intense, shooting left-sided jaw pain. She has experienced these attacks for several years, but they had previously been relatively rare. She says that episodes are sometimes brought on by eating but can occur without an apparent stimulus. The patient’s history is remarkable for herpes zoster infection. What potential sequelae do you need to be concerned about?

December 27, 2020 6:48 am Published by

Increased suicide risk