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At a national conference, a pharmaceutical representative reaches out to you and offers you an all-inclusive trip to the Bahamas to hear about their newest available preventative migraine therapy. As a resident, which is the most appropriate response:
A 3-day-old male infant is evaluated in the NICU for fever and focal seizures. He was born at 39 weeks gestation via uncomplicated vaginal delivery and had good APGAR scores. Brain imaging shows periventricular calcifications and severe ventriculomegaly. Auditory testing also demonstrates bilateral hearing impairment. What is the most likely cause of the patient’s symptoms?
A two-week-old female is evaluated in the clinic. Upon physical exam, you notice a dimple and overlying tuft of hair on her lower back. This finding is most likely associated with a defect that occurs during which week of gestation?
Pilocytic astrocytomas characteristically have which of the following genetic abnormalities?
The pathology shown in the image below is likely due to which of the following?
A 4-year-old girl with multiple seizure types and intellectual disability has an EEG performed that shows 1.5 Hz to 2.5 Hz spike and wave discharges. Which of the following 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?
Which of the following structures is well myelinated in a full-term (40-week) infant?
An MRI is performed on a 40-year-old man after experiencing his first unprovoked seizure. The lesion appreciated on the MRI T2 sequence shown below is most likely which of the following?
A 78-year-old male with a past medical history of diabetes presents to the clinic with a 2-year history of progressive lower extremity numbness and pain. He describes the pain as “pins and needles”. Physical examination reveals loss of pinprick sensation to the ankles bilaterally, mute Achilles reflexes, and moderate difficulty with tandem gait. A diagnosis is made based on examination and clinical history. What is the mechanism of action of the most appropriate first-line therapeutic agent?
Which of the following areas, if selectively lesioned, would cause an error with voluntary vertical saccades with spared horizontal saccades and sparred occulocephalic vertical reflex?
Based on the histopathologic findings shown below, how long ago did this patient experience an ischemic stroke?
You are caring for a 50-year-old with amyotrophic lateral sclerosis (ALS). Which of the following disorders is most likely to also develop in patients with ALS?
An 11-month-old male is brought to the emergency room with agitation, fever, and nuchal rigidity. A review of the patient’s electronic medical record shows that the patient was admitted with meningitis 2 months ago. While no clear focal neurological symptoms were appreciated on examination, there was a midline dimple appreciated in the lumbosacral region. Which of the following is the most likely etiology of the patient’s recurrent illness?
Which of the following medications is considered a first-line agent for the management of juvenile myoclonic epilepsy?
Which of the following vessels drains into the sigmoid sinus?
Narcolepsy is associated with which of the following HLA alleles?
Which of the following is not typically treated with indomethacin?
A 38-year-old man visiting from India presents to your clinic as a new patient for months of weakness in bilateral ankles to dorsiflexion and plantar flexion. On exam, he has diminished reflexes. He had an EMG done recently, showing axonal neuropathy in the lower extremities. He does not have his medication list with him, but he states he has taken a medication prescribed in India for “a cough” for several months. Which of the following labs would provide the highest yield?
Which of the following is the most likely diagnosis based on the EMG provided below?
Socially inappropriate behavior, disinhibition, echopraxia, and utilization behavior are typically seen in which of the following?
A 14-year-old girl with no significant past medical history presents with an acute presentation of left-sided weakness. CTH was negative but MRI shows an acute lacunar ischemic stroke in the right hemisphere. An angiogram was performed which revealed segmental arterial constriction followed by segments of arterial dilation in multiple intracranial vessels. Which of the following is the most likely etiology of her ischemic stroke?
Which of the following is the thalamic relay center for auditory stimuli?
A 32-year-old female presents to the emergency room after a motor vehicle accident as a restrained back seat passenger. Her only complaint on arrival is back pain. She has bruises across her abdomen and chest and a normal neurological exam. Thoracic spine imaging was completed and is shown below. Which of the following is the most likely diagnosis?
The F wave response is an:
Which of the following embryologic derivatives myelinates the peripheral nervous system (PNS)?
Which of the following is the mechanism of action of pimavanserin?
Which of the following findings is depicted in the catheter angiogram shown?
A 65-year-old female presents with an abrupt onset of akinetic mutism, lack of motivation, apathy, bilateral leg weakness, and incontinence. A lesion to which of the following vascular territories could explain her symptoms?
A 56-year-old man with a history of a kidney transplant, on tacrolimus, presented to the hospital with a 2-week history of progressive confusion and expressive aphasia. An MRI brain with and without contrast was performed and shown below. A brain biopsy was performed and showed microglial nodules with encysted bradyzoites and tachyzoites. Which of the following is the most appropriate therapy?
What is the benefit of using glucocorticoids in the treatment of bacterial meningitis?
Metachromatic leukodystrophy is due to a deficiency of which of the following enzymes?
A two-week-old, full-term female with an uncomplicated delivery is brought to the clinic with abnormal jerky movements. Her father states that episodes occur right after the patient is put down for a nap, last for roughly 3 minutes, and resolve with arousal. During the episodes, the patient has rapid, repetitive myoclonic movements of her upper limbs. The physical exam is unremarkable. The patient was admitted to the Epilepsy Monitoring Unit where a typical event was captured and had no EEG correlate. Which of the following is the most likely diagnosis?
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 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?
A 26-year-old male suffered a spinal cord injury after falling from a ladder while hanging Christmas lights. In the ICU, he is experiencing episodes of sudden extreme increases in blood pressure, bradycardia, and diaphoresis. This condition is seen most commonly in lesions of which spinal cord levels?
Identify the pathological abnormality shown in the image below.
A patient presents with double vision that improves when tilting their head to the right. A lesion is most likely to be present in which of the following cranial nerves?
A 37-year-old man with poorly controlled diabetes mellitus presents to the emergency department with a three-day history of progressive headache, fever, and double vision. Examination shows bilateral proptosis, peri-ocular erythema, and ophthalmoplegia. CT of the head was ordered and showed bony destruction of the sinuses. Based on the most likely diagnosis, which of the following is the most appropriate treatment?
The EEG shown below is consistent with which of the following?