Nervous System & Special Senses


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M34_F1.jpg"}},{"insert":"\n\n"},{"insert":"17-year-old Kevin has been your patient since he was five. He suffers from neurofibromatosis type I, often known as Von Recklinghausen\u0027s disease.\r\n \r\nBeing the only patient of yours with the condition, you remember clearly the day the two of you first met.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M34_F2.jpg"}},{"insert":"\n\n"},{"insert":"You weren\u0027t feeling your best that day, nursing a steadily worsening caffeine-induced headache, the common affliction of a young doctor. \r\n \r\nRegardless, the line of patients in waiting wasn\u0027t going anywhere and you were determined to do your best for each one.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M34_F3.jpg"}},{"insert":"\n\n"},{"insert":"A young woman was next. As she poked her head through the door, excusing herself, you noticed a small wide-eyed boy of around five appraising you from behind her.\r\n\r\nKevin had come in for his regular check-up that day.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M34_F4.jpg"}},{"insert":"\n\n"},{"insert":"You had found several tiny light brown macules on Kevin\u0027s back while examining him. His mother said they had been there since age three. \r\n\r\nThe macules had progressively become larger and darker since. You counted seven, ranging from 5-7 mm in diameter, observing a similar lesion in the axillary region.\n\nThere were no other abnormal examination findings, and Kevin was within the normal height and weight ranges for his age.\r\n \r\nHis mother had mentioned that her father, Kevin\u0027s maternal grandfather, died of a cerebrovascular event at the age of 68. There was no history of cancer or hereditary disease in the family.\n"}]}


{"ops":[{"insert":"Which of the following did you perform during Kevin\u0027s initial work up?\n"}]}
1. A skin biopsy
2. A brain MRI
3. Referral to an ophthalmologist