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A 72-year-old male with diabetes, hyperlipidemia, and tobacco abuse is admitted to the stroke service after he is found to have a left superior middle cerebral artery territory stroke. His EKG on admission showed a normal sinus rhythm. A transthoracic echocardiogram (TTE) is performed. Which of the following findings on TTE would lead to the recommendation of an anticoagulant medication over an antiplatelet medication for secondary stroke prevention?
A 51-year-old woman with a past medical history of migraines and irritable bowel syndrome comes to the physician because of abnormal shaking of both hands for the past two months. The shaking improves after two glasses of wine. Examination shows symmetric hand tremors that worsen when the patient reaches for objects in front of her. What is the mechanism of action of the most appropriate first-line treatment?
Metachromatic leukodystrophy is due to a deficiency of which of the following enzymes?
A 44-year-old woman who was recently started on a new abortive therapy for her migraines presents with a new type of headache described as more severe and with an extremely rapid onset. CT head imaging revealed no acute findings and lumbar puncture testing was unremarkable. Which of the following is the most likely diagnosis?
Which of the following is the most likely cause of the findings seen on this gross pathology image?
A patient with a past medical history of Parkinson’s disease is brought to the emergency room with the chief complaint of a severe headache, chest pain, and shortness of breath. His blood pressure on arrival was 196/122 mmHg. The patient states that he was in his usual state of health earlier in the day but started feeling unwell after attending a wine and cheese pairing event at a local winery. Which of the following medications is likely the cause of the patient’s symptoms?
A 37-year-old female with a PMH of Sjogren’s, and a recent motor vehicle accident (MVA) is referred to the EMG Lab for evaluation of right arm pain/weakness. The patient endorses right head pain which radiates down her neck into the right shoulder and wrist. Examination shows 5/5 strength in the upper extremities except for 4+/5 deltoid and 4+/5 biceps strength in the right upper extremity. Sensation to light touch was intact throughout. Sensory nerve conduction studies of the right upper extremity were normal. Based on the patient’s EMG results outlined below what is the most likely diagnosis?
Which of the following is the mechanism of action of ropinirole?
A 9-year-old boy with no significant past medical history was referred to get an EEG because of declining school performance and concern for staring vs. daydreaming episodes. Hyperventilation was performed and shown below. His EEG was otherwise unremarkable. Based on the available data which is the most appropriate next clinical step?
The pathology seen in the image below is most likely related to maternal use of which of the following medications?
The abnormalities appreciated on the MRI below are due to a defect in which of the following processes?
A 45-year-old female with a recent diagnosis of multiple sclerosis, based on MRI and CSF analysis, is referred to your clinic to discuss possible disease-modifying therapies. You review the clinical history with her and she states that for the past 18 months she has experienced progressive right upper and lower extremity weakness. She denies any periods of transient improvement or dramatic worsening of symptoms. Based on this clinical history, what is the most appropriate disease-modifying therapy for this patient?
A 40-year-old male with bilateral mesial sclerosis and medically refractory epilepsy presents to the epilepsy monitoring unit for a presurgical evaluation. His current anti-seizure medication regimen includes levetiracetam, lamotrigine, and clobazam. Over three days and weaned medication, the patient had 7 seizures; four from the left temporal lobe, and three from the right temporal lobe. Which of the following is the most appropriate next step in treatment?
A 6-month-old full-term female is referred to the clinic with persistent right shoulder and elbow weakness since birth. Which of the following is the most likely pathologic lesion?
Which of the following is the most appropriate initial screening test for suspected restless leg syndrome?