QuestionSBA
QuestionChoice
Retinoblastoma is a malignant tumour of the retina, and the most common intraocular tumour of childhood. The most common sign of retinoblastoma is leukocoria (white pupil). However, it may also present as deteriorating vision, strabismus or failure to thrive if not recognised early. It is not a relevant differential in this case.
10005287
b
Retinoblastoma
QuestionChoice
This is a typical description of Horner's syndrome which is characterised by ptosis and miosis, with or without anhidrosis. It is due to an interruption of the sympathetic nerve supply to the eye and can be classified into pre-ganglion causes, post-ganglionic causes and central causes. In this case, with the weight loss and shoulder pain, the most likely underlying cause is a pancoast tumour of the apex of the lung. Pancoast tumours are pre-ganglionic lesions and, thereby, the anhydrosis affects the face only.
10005286
a
Horner's syndrome
QuestionChoice
A cluster headache is a unilateral headache that is typically worse around the eye. Typical features include a bloodshot or teary eye, vomiting and severe headache. None of these symptoms feature in this case.
10005289
d
Cluster headache
QuestionChoice
Multiple sclerosis, not unlike cerebrovascular disease is a multifocal condition which causes wildly variable clinical features dependent on the affected area of the brain or spinal cord. This said, there are typical presentations which may occur more commonly, in particular sensory disease (patchy paraesthesia), optic neuritis (loss of central vision and painful eye movements) and internuclear ophthalmoplegia (a lesion in the medial longitudinal fasciculus of the brainstem). It is highly unlikely to present with shoulder pain or anhidrosis.
10005288
c
Multiple sclerosis
QuestionChoice
Neuroblastoma is a rare cancer that affects children, mostly under the age of five years. It develops in early nerve cells called neuroblasts and often starts with a lump in the abdomen. It is not a relevant differential in this case.
10005290
e
Neuroblastoma
Concept
Chapter
2693
4339
Horner's syndrome
Topic
132
Respiratory
13604
A 75-year-old male presents to his GP. He complains of right-sided shoulder pain and of his face looking unusual for a reason he cannot pinpoint. With his face only, he has also been noticing that one side does not sweat at all. On further questioning, he reveals he has had significant weight loss in the past few months too. On examination, it is noted that he has right sided-miosis, ptosis and this is also the side he complains of facial anhidrosis.

Which of the following is the most likely diagnosis?
a