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A 42-year-old welder complains of a one-year history of progressive resting tremor, shuffling gait, and drooling. He consults a physician because of frequent falls and worsening fatigue. A diagnosis of a particular type of metal toxicity was made and treatment is started. Which of the following would most likely be found if an MRI brain if ordered?
A 56-year-old male comes to the clinic with a burning and tingling sensation in his feet and hands for the past 4 months. He has a history of morbid obesity and underwent gastric bypass surgery last year. On physical exam, he has 3+ ankle and patellar reflexes. He also has a positive Babinski and positive Romberg sign. There is impaired position and vibration sense in his big toe bilaterally. This patient’s condition is most likely due to a deficiency of which of the following?
Which of the following is the reversal agent for apixaban?
Based on the EEG shown below, how old is this patient?
A previously healthy 15-year-old male presents to the emergency room after experiencing a concussion while playing soccer. He is now back to baseline but to be thorough the ED physician orders an MRI which is shown below. What is the lesion shown in this MRI?
An 82-year-old woman donated her brain to science for post-mortem analysis (see below). Which of the following symptoms did the patient most likely experience before her passing?
A 19-year-old male presents to the ED during finals week of college after he had witnessed generalized convulsive activity on the floor of his dorm room. He has since returned to baseline. He states he has never had shaking like this before, other than when he wakes in the morning he’ll get an occasional twitch or two. An EEG is performed as below. Which is the treatment of choice?
An 11-year-old female presents with worsening stiffness. She had no complications while in utero or at birth, yet ever since she started kindergarten she noted to have stiffness in her feet and ankles, which worsens by the end of the day. She eventually started to notice modest stiffness in the legs and mild stiffness in the neck. She underwent physical therapy for this and remained stable. Over the last 2 years, however, the symptoms have been worsening. Which of the following next steps is most indicated?
A 68-year-old male presents with complaints of insomnia for 2 years. On further questioning, he also endorses a 2 years period of feelings of guilt about his sleeping, considerably low appetite (current BMI = 17), and low energy. He used to enjoy checkers but has lost interest in most activities these days. He denies suicidal ideation. He has previously declined medications to help with this, but he says he is ready to try something. Which of the following medications is most appropriate?
Which of the following is the mechanism of action for natalizumab?
Which of the following forms of Charcot-Marie-Tooth (CMT) disease causes axonal polyneuropathy?
The imaging shown below is most consistent with which of the following diseases?
An 80-year-old woman with uncontrolled HTN presents to the ED with symptoms upon awakening of left hemi-sensory loss, last seen well 8 hours prior. MRI is done and shows a lateral thalamic lacunar stroke. The small branch affected in this lacune is most often a branch of which major artery?
Which of the following is true regarding IVIG and PLEX therapy?
You are reading a visual evoked potential (VEP) that has a prolonged P100 latency in the right eye and a normal latency in the left eye. Of the following, which pathology is most consistent with this study?
Which of the following is most likely to be damaged by carbon monoxide toxicity?
A 6-month-old male is admitted to the ED for acute respiratory failure. On examination, he has generalized weakness, diffuse hypotonia, and areflexia. He was admitted to the pediatric Intensive Care Unit and intubated. A chest X-ray showed a narrow chest. EMG/NCS was performed showing axonal motor polyneuropathy with tongue fasciculations and signs of chronic denervation. What is the most likely pathologic etiology causing this presentation?
Which of the following is the antibody associated with dermatomyositis that is known to confer the highest risk of cancer?
Eteplirsen is an effective treatment in patients with Duchenne muscular dystrophy (DMD) that have which of the following dystrophin mutations?
A lesion to which of the following hypothalamic nuclei causes hyperphagia?
Identify the lesion below.
A 55-year-old male presents with progressive worsening new headache over several months. He did not wish to seek medical attention but now presents because his family reports his facial expressions “look different”. On exam, he has impaired upgaze, light near dissociation, and convergence retraction nystagmus. An MRI is done and shows a lesion. Where is the lesion likely located?
A 45-year-old male presents with left-sided neck and shoulder pain. On examination, there is right arm abduction weakness and decreased bicep and brachioradialis reflexes. An EMG was ordered and showed fibrillations of the deltoids, supraspinatus, and biceps muscles. EMG testing of the triceps, first dorsal interosseous, abductor policies brevis, and rhomboid muscles were normal. These findings are most likely due to radiculopathy of which of the following nerve roots?
Which of the following features on EMG is suggestive of chronic denervation?
A 30-year-old male presents with progressive dysphagia over the last month. Head imaging is completed and shown below. Which of the following is the most likely diagnosis?