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A 32-year-old female comes into the clinic with a continuous, throbbing headache for 5 months. The pain is unilateral near the temple. The headache is constant but there are periods of pain exacerbations that can last from minutes to days and are debilitating. There is associated lacrimation and rhinorrhea on the ipsilateral side. What is the most likely diagnosis?
The abnormalities appreciated on the MRI below are due to a defect in which of the following processes?
A patient with a history of a chronic ischemic stroke has an MRI performed for new-onset seizures. Based on the imaging provided, what is the likely etiology of the patient’s past stroke?
A previously healthy 14-year-old female presents to the emergency room after experiencing a trip and fall where she hit her head. She returns to baseline, but out of caution a CT head and subsequent MRI brain are performed in the ED. What is a potential complication caused by this lesion seen in this MRI?
A 35-year-old man developed a right clavicle fracture after an accidental fall from a ladder while hanging Christmas lights. He was treated conservatively with a figure-of-eight bandage and sling. He presents to your clinic 2 weeks after the accident. He states ever since the accident he has had right arm and shoulder pain, as well as numbness extending from his triceps to his middle dorsal aspect of the forearm, wrist, and dorsal aspect of digits 1,2 and 3. On examination, his strength is 5/5 throughout all extremities except 4/5 to abduction of the deltoid, extension of the triceps, and wrist extension.
Which nerve or cord, if injured by the clavicle fracture, would explain his symptoms?
A 62-year-old 50 kg female with a history of myasthenia gravis presents to the hospital with shortness of breath and generalized weakness felt to be secondary to a myasthenic crisis. Her medication history in the chart states she is currently taking pyridostigmine 60 mg QID, prednisone 20 mg daily, and just started cyclophosphamide 4 weeks ago. She was safely intubated in the ED with a NIF of -18 cm H2O and a VC of 600 ml. Select the appropriate next steps regarding pharmacotherapy and management for a myasthenic crisis.
I. Discontinue pyridostigmine
II. Increase the dose of prednisone
III. Increase the dose of azathioprine
IV. Consult general surgery for thymectomy
V. Consider PLEX or IVIg therapy
VI. Start rituximab
A 53-year-old man has had increasing difficulty falling and staying asleep over the past 3 months. This is accompanied by hallucinations, delirium, and general clumsiness. He was an orphan as a child and does not know his family’s medical history. If a sleep study is performed, during which stage of sleep would you most likely expect to find an absence of normal sleep architecture?
Of the following, which region of the adult brain is most susceptible to hypoperfusion injury and ischemia?
A 75-year-old man with a past medical history of hypertension, hyperlipidemia, and diabetes presents with acute onset right arm weakness and speech problems. He can speak fluently and his comprehension is intact. However, he is unable to repeat even simple sentences. Reading and writing are preserved. Which of the following is an accurate description of his speech dysfunction?
What is the mechanism of action of pregabalin?
Which of the following is the antibody associated with dermatomyositis that is known to confer the highest risk of cancer?
Which of the following drug-mechanism pairs is incorrect?
A 58-year-old male with a prolonged history of MG was recently discharged 4 months ago from the hospital with his second myasthenic crisis requiring transient intubation. Since that hospitalization, he was on prednisone, tapered down to 40 mg a day, cyclosporine, and pyridostigmine. He comes to the ED today after having a generalized tonic-clonic seizure. On arrival to the ED, the patient is post-ictal and has vision deficits on exam. MRI shows T2 hyperintensities on the posterior cerebral hemispheres. Which of the following is the likely etiology of the clinical presentation?
A 68-year-old woman with a history of diabetes and hypertension presented urgently to the ED with a 2-day history of headaches and confusion. Before any imaging was able to be completed in the emergency room, the patient had a cardiac arrest and died. An autopsy was requested by the family. A gross pathologic image of the patient’s brain is shown below. What is the most likely etiology of the findings seen in this image?
A 40-year-old male is brought to the emergency room unresponsive after getting into a motor vehicle accident. On physical exam, his pupils are equally reactive to light. He can close his eyes and look up and down but not side to side. His motor exam otherwise has 0/5 strength symmetrically. The Babinski reflex is upgoing bilaterally. These symptoms can be explained by occlusion of which of the following vessels?
A 40-year-old man comes into the clinic with headaches. He has stabbing pain around the left temple that occurs numerous times during the day. The pain lasts 10-30 seconds at a time. He says he has excessive tearing from the left eye during these episodes. What is the most appropriate therapy?
An 8-year-old boy with no significant past medical history is brought to the clinic due to difficulties in school. His mother states that over the past year, she has received multiple phone calls from his teacher about his lack of concentration in class. On multiple occasions when asked a question, the patient would blankly stare at the wall and ignore the teacher, but then would return to his normal, talkative self immediately after each episode. An EEG is ordered, which shows 3 Hz generalized spike and wave discharges. The patient would most likely benefit from a medication targeting what?
You are caring for a 78-year-old man with slowly progressive memory loss and behavioral change. You are concerned about either frontotemporal dementia (FTD) or Alzheimer’s disease (AD). Which of the following tests would be the most sensitive and specific in differentiating the two?
What is the mechanism of action of dabigatran?
An 18-year-old woman with a history of symptomatic epilepsy presents with medically-refractory seizures. An MRI brain is performed during presurgical evaluation and reveals the non-contrast-enhancing lesion shown below on T2 FLAIR. This lesion is most likely which of the following?