For the past 5 weeks a 35-year-old woman has had episodes of intense vertigo lasting several hours. Each ep- isode is associated with tinnitus and a sense of fullness in the right ear; during the attacks, she prefers to lie on her left side. Examination during an attack shows that she has fine rotary nystagmus, which is maximal on gaze to the left. There are no ocular palsies, cranial-nerve signs, or long-tract signs. An audiogram shows high-tone hearing loss in the right ear, with recruitment but no tone decay. The most likely diagnosis in this case is 

A 25-year-old woman presents to the emergency department with a severe, throbbing headache of the right supraorbital area for the past hour. She also complains of nausea and photophobia. She has had similar attacks in the past, often brought on by menstruation. About 45 min ago she took 400 mg of ibuprofen. Which of the following would be the best therapeutic choice at this time? 

A 29-year-old woman who uses oral contraceptives comes to the emergency room because when she looked in the mirror this morning, her face was twisted. It felt numb and swollen. While eating breakfast, she found that her food tasted different and she drooled out of the right side of her mouth when swallowing. Neuro- logic examination discloses only a dense right facial paresis equally involving the frontalis, orbicularis oculi, and orbicularis oris. Finger rubbing is appreciated as louder in the right ear than in the left. The physician should 

A 78-year-old woman with metastatic breast can- cer arrives in your clinic for evaluation. She is currently receiving palliative chemotherapy. The patient lives with her husband and her 40-year-old son. Over the past several months she has fractured two vertebral bodies and has been hospitalized for a deep venous thrombosis. Both she and her family have sought aggressive treatment. Her hus- band is ill from advanced coronary artery disease, and the patient is his primary caregiver. Unfortunately, as her dis- ease has progressed she has become too sick to care for her husband. Her pain remains poorly controlled, and she is receiving naproxen and morphine, in both the long- acting as well as immediate-release form. She has lost 11.5 kg (25 lb) over the past 3 months, and her appetite is described as poor. On further questioning the patient volunteers that she feels her future is over and that only pain and suffering lie ahead. The patient is gravely wor- ried about the care her husband will receive in the future with her loss. She feels she is no longer able to serve as his caregiver and feels saddened by this. She is focused on the suffering she is putting both her husband and friends and family through with her physical and emo- tional decline. She states that she is sad and nervous about the future and has been unable to focus on anything else. Which of the following diagnoses best describes the men- tal status of this patient? 

A 45-year-old man presents with a daily headache. He describes two attacks per day over the past 3 weeks. Each attack lasts about an hour and awakens the patient from sleep. The patient has noted associated tearing and reddening of his right eye as well as nasal stuffiness. The pain is deep, excruciating, and limited to the right side of the head. The neurologic examination is nonfocal. The most likely diagnosis of this patient’s headache is