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Which of the following medications is considered a first-line agent for the management of juvenile myoclonic epilepsy?
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 is the mechanism of action of tetrabenazine?
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?
Which of the following genetic disorders is most commonly associated with holoprosencephaly?
The paraspinal muscles are innervated by which of the following?
What is the electrographic pattern seen best in the right temporal electrodes?
On microscopic evaluation, which of the following is a classic finding present in the Parkinson-plus syndromes of both progressive supranuclear palsy and corticobasal degeneration, but not Parkinson’s disease?
An 8-year-old girl is noted to have staring spells during class by her teacher. In the office, you are able to provoke an event by having her blow repeatedly into a pinwheel. What is the most likely underlying pathology of her disease?
Which of the following vessels drains into the sigmoid sinus?
A 56-year-old right-handed man is brought to the emergency room for new-onset aphasia. On exam, he cannot write, perform simple calculations, name his own fingers, and cannot distinguish with accuracy between his right and left sides. A lesion in which area can explain his symptoms?
A 37-year-old retired nurse is being evaluated in the emergency room for excessive diarrhea. She has been in the emergency department multiple times in the past for similar complaints and diagnostic testing has repeatedly been unremarkable. While casually talking to the nursing staff, the patient accidentally knocks over her purse and several bottles of laxatives fall out. Which of the following is the most likely diagnosis?
Which of the following medications is an acetylcholinesterase inhibitor that is FDA approved in the U.S. for the treatment of severe Alzheimer’s disease?
A 20-year-old male presents to your clinic for weakness. He is the star baseball player at the local university, but during the season his batting average has been dropping, and he finds he is having trouble standing on his toes, performing overhead shoulder presses, and more recently ascending steps. You give him a script for some blood testing and an EMG/NCS and schedule a follow-up in 2 weeks.
Unfortunately, shortly after returning home he had a fall down a flight of stairs and sustained a compound radius fracture. He was taken to the emergency room where an open reduction and fixation (ORIF) was performed. Shortly after the surgery, he developed tachycardia, tachypnea, and masseter muscle contractions, which then progressed to fever and rigidity.
Which of the following test results is most likely to be seen in this patient?
Which of the following correctly identifies the cranial nerve(s) that transverse through the structure (blue arrow) shown below?
A 62-year-old 50 kg female with a history of myasthenia gravis presents to the hospital with shortness of breath and generalized weakness felt to be secondary to a myasthenic crisis. Her medication history in the chart states she is currently taking pyridostigmine 60 mg QID, prednisone 20 mg daily, and just started cyclophosphamide 4 weeks ago. She was safely intubated in the ED with a NIF of -18 cm H2O and a VC of 600 ml. Select the appropriate next steps regarding pharmacotherapy and management for a myasthenic crisis.
I. Discontinue pyridostigmine
II. Increase the dose of prednisone
III. Increase the dose of azathioprine
IV. Consult general surgery for thymectomy
V. Consider PLEX or IVIg therapy
VI. Start rituximab
The combination of lamotrigine and which of the following drugs increases the risk of lamotrigine toxicity?
What is the most appropriate therapy for the infection depicted in the pathology slide below?
A 30-year-old man with a past medical history of migraines presents to the emergency department for his typical migraine symptoms, which have become intractable. He is treated with a “migraine cocktail” (normal saline, acetaminophen, and prochlorperazine) with some improvement. You are then called to the bedside for concern that he is having a possible seizure. His head is turned forcibly to the right without eye deviation and he is able to follow commands and verbalize. Which of the following is the best next step in management?
Which of the following cranial nerve(s) transverses through the structure (blue arrow) shown below?
The pathologic findings marked by the blue arrows in the image below are most likely which of the following?
An 18-year-old male presents to the ED after having his first generalized tonic-clonic seizure. MRI was unremarkable but a routine EEG showed 4-6 Hz polyspike and wave discharges in sleep. Which of the following antiepileptic drugs are most appropriate to start based on the available information?
Which of the following is a common side effect of levodopa therapy?
Which of the following is the chemoreceptor trigger zone for vomiting?
A 36-year-old woman was recently started on natalizumab for management of her multiple sclerosis. Over the next several months, she develops progressive weakness, incoordination, and speech disturbances before passing away six months after initiating natalizumab. Testing for which of the following pathogens should have been performed prior to natalizumab initiation to prevent this outcome?
The lesion shown below (blue arrow) is most consistent with which of the following pathologies?
A 5-year-old male presents because of muscle stiffness. His symptoms are worse during the colder winter months and with gym class at school. He sometimes becomes so stiff he can hardly breathe. Examination shows no muscle atrophy or hypertrophy but myotonia is present. Upon further questioning, you learn he has an older brother with similar symptoms. What is the likely dysfunctional gene in this patient?
A 39-year-old male presents with right-sided weakness and aphasia. NIHSS is 22 on physical exam. He was last known well 2.5 hours prior. The past medical history does not reveal any contraindications to tPA. A CT head is done and shows a hyperdense left MCA sign. The tPA is mixed by the nursing staff while you consent his wife for its administration. When you return to the bedside his aphasia has improved but his NIHSS is still 13. The blood pressure is 189/105 and the glucose is 225. What is the most appropriate next step?
Gaucher disease is caused by a homozygous mutation in the GBA gene which encodes the enzyme beta-glucocerebrosidase. Which of the following neurologic disorders is also linked to mutations, both homozygous and heterozygous, in the GBA gene?
Which of the following EEG artifacts is prominently seen on this EEG?
Which of the following medications is approved only for moderate to severe Alzheimer’s Disease?
Which of the following CSF findings would be expected in a patient with AIDP?
A 49-year-old female has had a 6-month history of difficulty swallowing and weight loss. On examination, she has generalized muscle loss. On strength examination, she has 3/5 proximally and 4/5 distally in the bilateral upper extremities. There are normal tongue movements and a normal jaw jerk reflex. Deep tendon reflexes in the bilateral upper extremities are normal and sensation is intact. An EMG is performed and outlined below. What is the most likely diagnosis?
A 57-year-old male with HIV who is non-compliant with HAART therapy presented to the emergency room with a 4-week history of altered mental status and falls. On neurological examination, the patient was altered, ataxic, and had right upper extremity weakness. An MRI was performed and shown below. Based on the clinical presentation and imaging provided, what is the most appropriate first step in medical management?
A 32-year-old male with a longstanding history of epilepsy secondary to mesial temporal sclerosis returns to your clinic. Despite being on appropriate doses of levetiracetam and valproic acid he continues to have 20 partial seizures and 4 generalized tonic-clonic seizures per month. Which of the following is the next best step in his care?
Which of the following muscles is solely innervated by the C5 nerve root?
Which of the following can increase the risk of seizures while taking bupropion?
A 48-year-old woman presents with acute onset of seizures, myoclonus, ataxia, and rapidly progressive dementia. CSF analysis reveals an elevated protein and mild pleocytosis. Brain MRI with and without contrast is unremarkable. Further investigation reveals elevated thyroid-stimulating hormone levels and anti-thyroid peroxidase antibodies. Which of the following is the most appropriate therapy?
Which of the following anti-seizure medications carries the highest risk of major congenital malformations?
A 35-year-old male with a history of intravenous drug use was found unresponsive with a used syringe at his side. After 30 minutes of CPR, there was a return of spontaneous circulation. A CTH was performed (shown below). Which of the following is appreciated on imaging?