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1

A 58-year-old woman presents to the clinic with an abnormal sensation on the left side of her body that has been present for the past several months. At first, the area seemed numb and she recalls touching a hot stove and accidentally burning herself but not feeling the heat. Now she is suffering from a constant, uncomfortable burning pain on her left side for the past week. The pain gets worse when someone even lightly touches that side. She has recently immigrated and her past medical records are unavailable. Last month she had a stroke but she cannot recall any details from the event. She confirms a history of hypertension, type II diabetes mellitus, and bilateral knee pain. She also had cardiac surgery 20 years ago. She denies fever, mood changes, weight changes, and trauma to the head, neck, or limbs. Her blood pressure is 162/90 mm Hg, the heart rate is 82/min, and the respiratory rate is 15/min. Multiple old burn marks are visible on the left hand and forearm. Muscle strength is mildly reduced in the left upper and lower limbs. Hyperesthesia is noted in the left upper and lower limbs. Laboratory results are significant for: Hemoglobin 13.9 g/dL MCV 92 fL White blood cells 7,500/mm3 Platelets 278,000/mm3 Creatinine 1.3 U/L BUN 38 mg/dL TSH 2.5 uU/L Hemoglobin A1c 7.9% Vitamin B12 526 ng/L What is the most likely diagnosis?

AConversion disorder

BComplex regional pain syndrome

CDejerine-Roussy syndrome

DMedial medullary syndrome

ESubacute combined degeneration of spinal cord

2

A 58-year-old man comes to the physician because of burning pain in his neck and arms for a year. He has also had paresthesias in his hands during this period. He has had increasing weakness in both hands during the past 3 months. He has type 2 diabetes mellitus, hypercholesterolemia, and hypertension. He was involved in a motor vehicle collision 3 years ago. Current medications include metformin, sitagliptin, enalapril, atorvastatin, and aspirin. He has had 7 sexual partners in his lifetime; he uses condoms inconsistently. He is oriented to time, place, and person. Vital signs are within normal limits. The pupils are equal and reactive to light. Examination of the upper extremities shows decreased muscle strength, absent reflexes, and decreased hand grip with fasciculations bilaterally. Sensation to temperature and pain is absent over the chest and bilateral upper arms. Vibration and joint position sensations are present in the upper limbs. Cranial nerve examination shows no focal findings. Examination of the lower extremities show no abnormalities. Which of the following is the most likely diagnosis?

ABrown-Séquard syndrome

BTabes dorsalis

CMultiple sclerosis

DSyringomyelia

ECervical disk prolapse

3

A 17-year-old boy is brought to the emergency department after being stabbed with a knife during an altercation. Physical examination shows a 4-cm stab wound on the right lateral border of the T1 spinous process. An MRI of the spinal cord shows damage to the area of the right lateral corticospinal tract at the level of T1. Further evaluation will most likely show which of the following findings?

AAbsence of right-sided motor function below T1

BAbsence of left-sided proprioception below T1

CPresence of left-sided Babinski sign

DAbsence of left-sided fine touch sensation below T1

EAbsence of right-sided temperature sensation below T1

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