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An 18-year-old woman presents as a new patient to your clinic for “seizures”. On review of her medical records, you find that she has had numerous ED visits and inpatient admissions for generalized shaking spells. Several of them have been captured on video EEG recording and there was no EEG correlate with the behavior, suggesting that they are psychogenic non-epileptic attacks/spells (PNEA/PNES). She says she is seeing you today because “I need someone to refill my seizure medications.” Which of the following basic principles of medical ethics could be best applied to this scenario?
You have recently diagnosed an asymptomatic 45-year-old man with Huntington’s disease based on genetic testing which was requested based on a family history of the disease. The patient was informed of these findings in the clinic with his wife by his side. On the following day, you receive a phone call from the patient’s 23-year-old son asking what the results of the testing were. What is the most appropriate response to this question?
Which of the following is characteristic of a left internuclear ophthalmoplegia?
A 56-year-old woman with recent open-heart surgery develops sudden onset, painless right eye vision loss. On funduscopic examination, the optic disc appears swollen and pale. No other significant findings were appreciated on the funduscopic exam. Damage to which of the following structures is the most likely cause of the patient’s symptoms?
A 36-year-old woman presents with facial weakness. She states that symptoms started on the right side of the face one week ago, but since then the left side has also become progressively weak. Other pertinent complaints include dry cough, shortness of breath, and joint pain. MRI of the brain shows bilateral contrast enhancement of the facial nerves. Chest X-ray reveals bilateral hilar adenopathy. A diagnostic lymph node biopsy is performed. Which of the following is most likely appreciated on pathologic analysis?
A 27-year-old woman presents with recurrent episodes of tinnitus, vertigo, and hearing loss. She denies any associated headaches. Episodes typically last between 2 and 6 hours in duration. MRI of the brain with and without contrast did not reveal any pathology. Physical examination is unremarkable except for sensorineural hearing loss appreciated in the right ear. Which of the following is the most likely diagnosis?
A 25-year-old female presents with anisocoria; her right eye is significantly more dilated when compared to the left eye in ambient light. The right pupil is also irregular in shape, does not respond to light, and is sluggish to constrict to near accommodation. When dilute pilocarpine (0.125%) is administered to the right pupil it constricts but the left eye doesn’t react at all.
Which of the following is the most likely cause of the patients’ symptoms?
At a national conference, a pharmaceutical representative reaches out to you and offers you an all-inclusive trip to the Bahamas to hear about their newest available preventative migraine therapy. As a resident, which is the most appropriate response:
Which of the following is the most accurate statement regarding driving with epilepsy?
A 24-year-old weight-lifter presents after sudden-onset neck pain. On exam, there is right eye ptosis and asymmetric right pupil constriction. Additionally, the patient appreciated decreased sweat production on the right side of his face. 1% hydroxyamphetamine eye drops are administered to the right eye and it dilates. Where is the most likely site of the patient’s lesion?
A 38-year-old man presents with frequent headaches over the past year and recent development of polydipsia and polyuria. He has also been complaining of a dry cough, shortness of breath, and erythematous nodules along his shins bilaterally. MRI of the brain shows a contrast-enhancing lesion of the hypothalamus. Which of the following is the most likely diagnosis?
A 59-year-old woman presents to the emergency room with dizziness and left ear fullness. The symptom is described as a spinning sensation that is present at rest and with action. She has had comparable events before, which have self-resolved over time. The patient is ataxic on the exam and has difficulty hearing out of her left ear. An MRI brain with and without contrast was normal. Which of the following is the most appropriate line of therapy that will decrease the risk of future recurrent events?
A 38-year-old man with a past medical history of chronic cough, and shortness of breath presents with a three-week history of recurrent headaches, confusion, and difficulty with speech. On exam, there are difficulties with attention and mild aphasia. Additionally, there appear to be erythematous nodules along his shins bilaterally. Brain MRI shows a contrast-enhancing lesion in the left hemisphere. Due to the patient’s chronic pulmonary complaints, a chest X-ray is also performed. Which of the following is most likely seen on a chest X-ray?
A 72-year-old man with a history of right-sided carotid stenosis was transferred from an outside hospital to your institution to have a carotid stent placed after experiencing a mild right-hemispheric ischemic stroke. The patient was sent to the angiography lab and had a carotid stent placed, however, it was done so on the unaffected (left) side. What is this an example of?
A 48-year-old woman presents with acute onset of seizures, myoclonus, ataxia, and rapidly progressive dementia. CSF analysis reveals an elevated protein and mild pleocytosis. Brain MRI with and without contrast is unremarkable. Further investigation reveals elevated thyroid-stimulating hormone levels and anti-thyroid peroxidase antibodies. Which of the following is the most appropriate therapy?
Which of the following would not constitute or be concerning for a HIPAA violation?
Which of the following is the relay center for hearing?
A 45-year-old patient presents with complaints of new-onset double vision. On the general neurologic exam, you note the patient tilts their head to the left. The remainder of the physical exam is unremarkable. Which of the following is the most common underlying pathologic cause of this issue?
Bilateral exotropia is typically seen with which of the following lesions?
A patient with end-stage amyotrophic lateralized sclerosis (ALS) presents to the emergency room from a nursing home alone. His vitals show hypoxemia and he appears tachypneic on examination. On examination, he is also paraplegic with significant weakness in the upper extremities and mild dysarthria. His mental status examination appears intact. Between short breaths, he says that he does not wish to be intubated. This is consistent with the end-of-life discussions documented in the outpatient clinic notes. As his hypoxemia worsens his wife arrives at the bedside and with urgency asks you to intubate the patient. What is the most appropriate response?
A 35-year-old woman with a past medical history of ocular and oral dryness presents with a 5-month history of progressive difficulties with ambulation. On exam, there is diminished vibratory sensation along the plantar/dorsal surfaces of her feet, 1+ ankle reflexes bilaterally, and a positive Romberg sign. Strength is normal. A tissue biopsy confirms the diagnosis. Which of the following is the most likely diagnosis?
Initiating HAART therapy for a patient with poorly controlled HIV places them at an increased risk for which of the following?
Which of the following is the thalamic relay center for auditory stimuli?
A 68-year-old woman with no significant medical history presents in the emergency room with acute aphasia and right-sided weakness. Her wife who is in the room states the patient was last seen well one hour prior to arrival at the hospital. A CT scan of the head showed no acute hemorrhage. After screening the patient and discussing the risks and benefits of acute pharmacological therapy with her significant other the patient was given intravenous tPA. Thirty minutes later the patient had an acute neurological decline. She was sent for a repeat CT scan which showed a new 16 cc intraparenchymal hemorrhage in the left hemisphere. What is this an example of?
Which of the following is most commonly associated with NMDA-receptor encephalitis?
Which of the following findings on a Head-Impulse-Nystagmus-Test-of-Skew (HINTS) test is consistent with central vertigo?
A 62-year-old woman presents to your clinic with complaints of dizziness. She states that about 2 weeks ago she had some dental work done including a root canal, and ever since then has had spells of extreme dizziness. She describes that the room spins and she becomes sick to her stomach. The sensation is improved by sitting very still. It completely resolves in between episodes, and episodes happen about once or twice a day. She noticed that it happens consistently when she tries to back out of the driveway in the early morning. She had a CT head one day ago that was read as normal. On exam, she has inducible nystagmus. The otoscopic exam is normal. Which of the following is the most accurate statement?
A 38-year-old female presents for 5 weeks of worsening encephalopathy, and blurred vision. An MRI Brain with contrast is performed and shown below (T1 post-contrast, multiple axial sections). Of the following, what is the most likely diagnosis?
A 53-year-old Spanish-speaking woman comes to your clinic for the first time with complaints of memory loss. She is accompanied by her 16-year-old daughter who is bilingual. You quickly realize that the patient does not have a strong grasp of the English language. After proposing to use a professional translator the daughter says that she feels comfortable translating for her mother. What is the most appropriate next step?
A 35-year-old male presented for sudden onset painless central vision loss. An outside hospital emergency room physician suggested he may have had a CRAO, but recommended immediate ophthalmology outpatient evaluation. The patient was unfortunately lost to follow-up for a few months. He presents today due to a sudden onset of central vision loss in the other eye.
On your ophthalmologic exam, you note hyperemic optic nerve and tortuous central retinal vessels, without evidence of vessel cutoff. He has a central scotoma bilaterally, with peripheral vision intact. He has red color desaturation as well. MRI brain w/ and w/o contrast with fat suppression and thin cuts through the orbits is performed, and normal.
This disorder is caused by which of the following pathologic processes?
A patient with newly-diagnosed early state amyotrophic lateralized sclerosis (ALS) presents to your multidisciplinary clinic for the first time. After discussing the effectiveness and side effects of riluzole and endavarone, the patient informs you that he doesn’t want to start either medication. Which of the following basic principles of medical ethics could be best applied to this scenario?
Opsoclonus-Myoclonus Syndrome (OMS) is associated with which autoimmune antibody?
389 Patients who had acute unilateral optic neuritis were enrolled between 1988-1991 in a study and followed for 15 years to assess their risk for developing multiple sclerosis (MS). They found that the probability of developing MS within 15 years was 50%. What type of study was this?
A 65-year-old female presents to the clinic with painless double vision that started abruptly 5 days ago. On exam, pupils are equal, round, and reactive to light bilaterally. On extraocular muscle testing, the left eye has a normal range of motion but the right eye is unable to adduct or elevate. Which of the following is the most likely cause of the patient’s symptoms?
A study published in 1992 indiscriminately assigned 457 patients with optic neuritis to receive either 14 days of oral prednisone, 3 days of intravenous methylprednisolone followed by 11 days of prednisone, or an oral placebo for 14 days as an acute therapy. Visual function testing was performed intermittently over a six-month follow-up period. The results showed that patients who received methylprednisolone followed by oral prednisone had a faster rate of visual recovery. What type of study design was this?