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A patient recently diagnosed with multiple sclerosis was started on an oral disease-modifying therapy (DMT) that works on nuclear factor erythroid-derived 2-related factor (Nrf2)-dependent and independent pathways. One week later they call you complaining of flushing of the skin. What is the most appropriate next step in management?
Which of the following is the most sensitive test for myasthenia gravis (MG)?
A 34-year-old schoolteacher presents to the emergency department with confusion and weakness. Her family reports they have been staying at their cabin for labor day weekend and the patient spent the whole time inside complaining of generalized fatigue, myalgia, headache, and light sensitivity. They felt she had “a cold” so they let her rest. This morning, Monday, she was found in her bed unable to move and confused.
On exam, she is disoriented. She has nuchal rigidity. On musculoskeletal exam, she has diffuse but left > right weakness in the limbs. Her reflexes are 0/4 in the bilateral ankle, knee, and brachioradialis, and 1+ in the bilateral biceps. The sensory exam is normal.
The serum glucose is 100. Lumbar puncture is performed and shows glucose 60, protein 55, RBC 1, and WBC 25, lymphocyte-predominant.
Which of the following is the most appropriate preventive measure for this condition?
Which of the following nuclei of the hypothalamus is involved in temperature regulation?
Cerebral amyloid angiopathy would be best appreciated on which of the following MRI sequences?
A 65-year-old male presents with an acute onset of back pain, bilateral lower extremity weakness, and bladder incontinence. A physical exam reveals decreased strength and loss of pain and temperature sensation in both legs. Vibratory and light touch sensation and proprioception remain intact. A lesion to which of the following arteries would most likely be responsible for this clinical presentation?
A 68-year-old woman presents to the emergency room with a 3-month history of worsening cognition, ataxia, dysphagia, and periodic episodes of brachial dystonia, and facial grimacing. A continuous EEG was performed but no EEG correlate was seen with the abnormal movements. An autoimmune process is suspected. Which of the following serum autoantibodies is most likely present?
A 40-year-old man from Honduras presents to the emergency room after experiencing a first-time seizure. CT head showed multiple calcified intraparenchymal lesions. Physical examination in the emergency room was unremarkable except for the presence of multiple subcutaneous nodules. A biopsy of one of these nodules was completed and microscopic imaging of the lesion is shown below. What is the most likely diagnosis?
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?
Which of the following findings is depicted in the MR Angiogram shown below?
The MR angiogram shown below demonstrates which of the following?
A mother and father bring in their 8-month-old son to your clinic for clinical events described as sudden flexion of the limbs and trunk, seen most often upon awakening or falling asleep. His interictal EEG is demonstrated below. Which of the following is the most likely cause of the patient’s symptoms and EEG findings?
Which of the following is not part of Gerstmann’s syndrome?
A 24-year-old man comes to the emergency room with severe left-hand pain after a fall at home. The patient refuses to allow the nurse or doctor to do a physical exam. A hand X-ray is unremarkable. She insists that all she needs is a note for two weeks of paid leave from her job. Which of the following is the most likely diagnosis?
The pathologic findings on the image shown below can be secondary to bilateral mononeuropathies involving which of the following nerves?