1. A 30-year-old woman presents complaining of double vision and fatigue . Her
symptoms are absent in the morning but become progressively worse by the
end of the day . Physical examination reveals a heart rate of 90/min and a
blood pressure of 1 20175 mm Hg . Ophthalmologic examination is remarkable
for bilateral symmetric ptosis and intact pupillary responses bilaterally.
Weakness of the muscles of the hand is evident b ilaterally, but only after
multiple contraction s . Sensory exam . is completely normal and deep tendon
reflexes are intact.
1 . What i s the most likely diagnosis?
2. What tests and/or imaging tools could be used to confirm the
diagnosis?
3. What is the most appropriate treatment for this condition?
4. What is the potential complication of this condition and how
to manage? 2. A 20-year-old college student presents to the clinic with fever and headache .
The headache began the night before and has significantly disrupted her
routine. She describes it as a severe, non-pulsating headache , exacerbated by
moving her neck . She also notes that loud noises and bright lights seem to
bother her much more than usual .
On physical examination , her temperature is 3 9 . 1 °C , pulse is 1 1 0/min , and
the respiratory rate is 20/min. She is unable to touch her chin to her chest,
and she experiences significant pain upon flexion of her thigh with extension
of her leg . There is a macular purple rash over both legs, which she had not
noticed before . Her funduscopic exam is normal , and she has no focal
neurologic deficits .
A lumbar puncture reveals cloudy fluid and the following results : Protein: 75
g/dL, Gl ucose: 23 g/dL, WBCs: 678/mm3 , 98% neutrophils, RBCs: 5/mm3 .
Bacteria: none visualized
1. What is the most likely diagnosis?
2. Should this patient have undergone CT scan prior to lumbar
puncture?
3. What is the treatment of this condition. When should patients
receive steroids?
