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A 57-year-old man with a past medical history of bipolar disorder, atrial fibrillation, and type 2 diabetes presents to the clinic with complaints of a tremor. Symptoms have been present for years but they have not seemed to progress significantly over time. His current medications are warfarin, metformin, low-dose aspirin, and lithium. His neurological examination was unremarkable except for the presence of a fine, high-frequency tremor in his bilateral upper extremities. Based on the most likely diagnosis, what is the most appropriate next step in medical management?
A 40-year-old male presents to the clinic with difficulty swallowing. On additional questioning, he reports difficulty walking, falls, and dysarthria. Examination shows bilateral facial weakness, fasciculations, and gynecomastia. A CAG trinucleotide repeat on which of the following genes is the cause of this disease?
A 4-year-old female was brought to the emergency room for lethargy, ataxia, and nausea. MRI brain with contrast showed well-circumscribed, contrast-enhancing heterogeneous lesions in the 4th ventricle. Surgical resection was performed and histopathologic analysis was completed. Which of the following is the correct diagnosis?
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?
Which of the following is correct regarding the H-reflex?
A 65-year-old mechanical engineer presents with increasing word-finding difficulties. He is particularly concerned that he is forgetting the names of people, places, and objects. On examination, he has difficulty naming objects when shown (i.e. keys, watch, etc.). Otherwise, his speech is fluent. A SPECT scan shows hypometabolism in the left anterior temporal lobe. Which of the following is the most likely diagnosis?
An 87-year-old male presents with a 2-year history of worsening cognitive decline and speech difficulties. Brain MRI reveals multiple chronic cerebral infarcts. The neurological exam reveals adequate comprehension and fluency but naming was impaired. What is the most likely diagnosis?
This brain biopsy is consistent with which of the following pathologies?
An abnormal breathing pattern described as an initial prolonged inspiratory phase, inspiratory pause, and then incomplete expiration can localize to damage of which of the following regions along the neuraxis?
A 65-year-old woman with a history of a known right posterior communicating artery aneurysm comes to the emergency department with focal neurological symptoms. Brain MRI shows interval enlargement of the aneurysm. Which of the following clinical symptoms is most likely?
You are caring for a patient in the Neuro ICU for loss of consciousness after 3 convulsive episodes within a 2 hour period. She required intubation with rocuronium and sedation with propofol. She was loaded with 2000 mg of Keppra and had received 2 mg of Ativan in the ED. You obtain a spot EEG and left temporal epileptiform discharges are seen, but no additional seizures. Unfortunately, your hospital does not have continuous EEG capabilities. Of the following options, which physical exam change in this paralyzed patient is most likely to indicate potential repeat seizure and prompt stat repeat spot EEG and consideration of antiepileptic bolus?
Bilateral exotropia is typically seen with which of the following lesions?
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?
A 20-year-old female presents with complaints of 2 years of excessive daytime sleepiness and brain fog during the day. She reports sleeping is unrefreshing. In the morning she has difficulty waking up and feels an uncontrollable desire to go back to sleep. She denies difficulty staying asleep during the night and denies episodes of suddenly collapsing in stressful situations. She had a polysomnogram where she slept for 12 hours, had 4 apneic episodes per hour, had REM sleep onset latency of 7 minutes, and did not have sleep-onset REM periods (SOREMPs). Which of the following is her diagnosis?
This muscle biopsy is most consistent with which myopathic disease?