Quiz 05/26/2022

A 67-year-old man with a past medical history of obstructive sleep apnea is being evaluated for bilateral arm tremors. His symptoms started insidiously 5 years ago. It is best appreciated when the patient brushes his teeth or eats with a fork. Oddly, he has noticed that a glass of wine at night can help with his symptoms. What is the most appropriate therapy for his movement disorder?

A 10-month-old male with no significant past medical history has had a 2-month history of abnormal movements. The family describes these events as head drops and head-turning. On examination, horizontal nystagmus is appreciated. MRI revealed no abnormal findings. What is the most likely diagnosis?

A 65-year-old man with a past medical history of chronic liver disease and diabetes presents with progressive falls and a tremor. On exam, he is rigid throughout with significant gait instability, a tendency to turn his head to the right, and a hypertrophied left sternocleidomastoid muscle. He fails initial treatment with carbidopa-levodopa. His brain MRI reveals T1 hyperintensities of the bilateral globi pallidi. Which of the following is the most likely diagnosis?

A 7-year-old boy was brought to the ED by his mother for a three-week history of involuntary movements. He was initially seen by his pediatrician two weeks ago. MRI of the head was performed and was unremarkable. Methylphenidate was trialed for a presumed tic disorder but it had no benefit. The Movements resolve with sleep. On examination, he has difficulty controlling facial and extremity movements as well as maintaining tetanic contraction of his hands. There was also a newly appreciated cardiac murmur. What is the most likely diagnosis?

Which of the following is the mechanism of action of ropinirole?

A 68-year-old female presents to your clinic with the chief complaint of daytime somnolence. She endorses an unpleasant feeling in her lower extremities while trying to go to bed which prevents her from sleeping. Moving her limbs gives transient relief. What is the most appropriate first diagnostic test?

A 72-year-old female presents to the clinic with her husband who states that she is “seeing things that aren’t there”. For the past two weeks, she has been complaining of bats flying around her room at night. Comparable visual disturbances have occurred over the past year, but have gotten progressively worse recently. She has also been acting out a lot at night; her husband states that she has been violently kicking and flailing her arms while asleep. Finally, she has been experiencing cognitive decline, including forgetting where she lives, what year it is, and the names of her grandchildren. On exam, there is symmetric cog-wheel rigidity appreciated. What is the most likely diagnosis?

A 55-year-old male with a 3-year history of postural hypotension, incontinence, and ataxia comes to the clinic for evaluation. An MRI brain shows degeneration of the pontocerebellar and olivocerebellar fibers. What is the most likely diagnosis?

A 69-year-old male presents to the clinic with his wife who states that for the past 10 months the patient has become increasingly slow and more clumsy with daily activities. He has also been complaining of dizziness, especially in the morning when he first gets out of bed and has fallen once in the past month. On physical exam, it is observed that the patient has a 21 mmHg drop in systolic blood pressure when going from a sitting to a standing position. A brain MRI is ordered and shows a cruciform hypointensity in the pons. What is the most likely diagnosis?

A 57-year-old man with a past medical history of bipolar disorder, atrial fibrillation, and type 2 diabetes presents to the clinic with complaints of a tremor. Symptoms have been present for years but they have not seemed to progress significantly over time. His current medications are warfarin, metformin, low-dose aspirin, and lithium. His neurological examination was unremarkable except for the presence of a fine, high-frequency tremor in his bilateral upper extremities. Based on the most likely diagnosis, what is the most appropriate next step in medical management?