Which one of the following antibodies is associated with ocular opsoclonus-myoclonus in patients with breast cancer?
Correct Answer E:
Paraneoplastic syndromes affecting nervous system:
Lambert-Eaton myasthenic syndrome:
Anti-Hu:
Anti-Yo:
Anti-GAD antibody:
Anti-Ri:
A 24-year-old woman who is 14 weeks pregnant presents with a severe migraine. She has a long history of migraine and stopped propranolol prophylaxis when she found out she was pregnant. Unfortunately the headache has not responded to paracetamol 1g.
What is the most appropriate next step?
Correct Answer C:
Migraine: pregnancy, contraception and other hormonal factors:
SIGN produced guidelines in 2008 on the management of migraine, the following is selected highlights:
Migraine during pregnancy:
Migraine and the combined oral contraceptive (COC) pill:
Migraine and menstruation:
Migraine and hormone replacement therapy (HRT):
Which one of the following statements regarding Meniere's disease is correct?
Meniere's disease:
Meniere's disease is a disorder of the inner ear of unknown cause. It is characterized by excessive pressure and progressive dilation of the endolymphatic system. It is more common in middle-aged adults but may be seen at any age. Meniere's disease has a similar prevalence in both men and women.
Features:
Natural history:
Management:
A 39-year-old man is diagnosed as having cluster headaches. He has received subcutaneous sumatriptan on two occasions but would like to start medication to help prevent further attacks.
Of the following options, which one is the most suitable treatment?
Correct Answer D:
Cluster headache:
Cluster headaches* are more common in men (5:1) and smokers.
*Some neurologists use the term trigeminal autonomic cephalgia to group a number of conditions including cluster headache, paroxysmal hemicrania and short-lived unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). It is recommended such patients are referred for specialist assessment as specific treatment may be required, for example it is known paroxysmal hemicrania responds very well to indomethacin.
A young couple undergo a postcoital test as part of an infertility evaluation. Several hours after coitus, the cervical mucus is thick and tenacious. No sperm are seen in the mucus, although they are present in the vagina. Semen analysis is normal. Eight days later, the patient menstruates. Her basal body temperature (BBT) record for that cycle indicates ovulation and a normal luteal phase.
The most appropriate management of this patient is to:
The luteal phase of the menstrual cycle is about 14 days in most women. Differences in cycle length are due to differences in the proliferative phase length. The reason that the cervical mucus is progestational is that the test was done 6 days too late (A postcoital test is done at ovulation, which occurs 14 days prior to the NEXT menstrual period). The correct thing to do is to repeat the test 6 or 7 days earlier on the next cycle.
→ Since the test was done at the wrong time of the cycle, no assessment of male factor can be made at this time.
→ See answer to A.
→ Although estrogen may change the nature of the cervical mucus, the test was done at the wrong time in the cycle.
→ The basal body temperature chart indicates ovulation (biphasic); so there is no benefit at this time for clomiphene citrate therapy.
Click to expand