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An 85-year-old woman presents to the hospital with an acute onset of language impairment. On examination, she has difficulty with comprehension but her verbal fluency and repetition are normal. Which of the following best describes her deficits?
Which of the following is the primary source of norepinephrine in the brain?
A 38-year-old female presents to the clinic with episodes of facial pain. She reports episodes of sudden severe and debilitating sharp pain on her right face lasting a few seconds to a couple of minutes. These seem to be triggered by eating or lightly touching the face. Outside of these episodes, she is pain-free. She does not endorse any associated rhinorrhea, lacrimation, or facial flushing. What is the likely cause of her symptoms?
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 21-year-old woman with a past medical history of depression presents with recurrent episodes of out-of-body sensations lasting 30 seconds. This may be followed by 1-2 minutes of staring and unresponsiveness that she does not remember. She often remains confused for 10 minutes after an event. They occur 1-3 times every 2 weeks. An MRI brain is done and shows no pathology. Which test is the most diagnostically valuable next step in her workup?
Patients with Charcot-Marie Tooth disease that have the CMT1A phenotype will have which of the following genetic mutations?
Which of the following is present in the image shown below?
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?
Uncal herniation compressing on the structure marked below (black arrow) would lead to which of the following symptoms?
A consult is placed for paroxysmal episodes in a 6-day-old male infant born at 32 weeks gestation. According to his mother, the infant seems to be shivering a lot “like he is cold”. The mother states that she has been wrapping him in warm blankets and keeping the room at a warm temperature. On physical exam, the infant is alert and interactive, without persistent focal neurological deficits. However, when touching the left arm, the patient develops a fine tremor that resolves after flexing the affected limb. Vital signs are within normal limits. Which of the following is the most likely diagnosis?
A 40-year-old male presents with a one-day history of numbness of his right arm. This has never happened before, but he does report an episode of left leg weakness that self-resolved two years ago. The neurological examination confirms a sensory disturbance of his right arm. Sagittal MRI of the cervical spine is shown below (Left: T1, Middle: T1 with contrast, Right: T2). Which of the following is the most likely diagnosis?
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?
A 3-year-old female with a past medical history of recurrent sinus infections is brought to the clinic by her father because of unsteadiness on her feet for the past 4 months. Her father states that she began walking at 12 months. However, more recently, she has been losing her balance and has been falling. On physical exam, she has truncal ataxia and an ataxic gait. An ocular exam reveals dilation of the retinal capillaries. Labs are ordered that show an elevated alpha-fetoprotein. Which of the following is the most likely diagnosis?
A 65-year-old female comes to the clinic complaining of weakness in his extremities. Symptoms are more prominent in the legs than in the arms. Oddly, when he tries to exert himself, he notes an improvement in his strength. Neurodiagnostic testing reveals low amplitude compound muscle action potentials (CMAPs) with an increase in amplitude on high frequency (50 Hz) rapid repetitive stimulation. Which of the following malignancies is most closely associated with this patient’s neurologic syndrome?
An autopsy was performed on a 30-week gestational age stillborn infant. An image of the brain before histopathologic analysis is shown below. Which of the following was likely also appreciated during the autopsy?
A 2 month-old female is brought to the emergency room by her mother after she noticed abnormal movements concerning for possible seizure. The child was born at term and was the product of a normal pregnancy and delivery. While gathering a history, the child is lying on the bed still when you notice repetitive movements of his bilateral lower limbs. When her mother notices she picks up the patient and the movements resolve. What is the most likely diagnosis?
Which of the following is associated with a “delta brush” pattern on EEG?
Which of the following medications is approved only for moderate to severe Alzheimer’s Disease?
A 40-year-old textile worker is brought to the clinic for slowly progressive symptoms including shuffling gait, tremor, and profuse drooling. On examination, his speech is difficult to understand and there is cogwheel rigidity in his arms and legs. His tremor is most evident when his limbs are at rest. Exposure to which of the following is the most likely cause of the patients’ symptoms?
A 13-year-old male with a recent history of acute disseminated encephalomyelitis (ADEM) presents to the clinic for post-hospital follow-up. He has made a near-complete recovery from his illness but his parents want to know what is his risk of recurrence. What is the most accurate statement you can share with the parents?
A 65-year-old male with a history of alcoholic cirrhosis presents to the emergency department with dark black coffee-ground emesis. He is found to have a systolic blood pressure of 76/40 and is tachycardic to 120 BPM. Which nerve is most responsible for carrying the afferent fibers from carotid sinus baroreceptors that cause the reflex increase in heart rate seen in this patient?
A 71-year-old female with a past medical history of hypertension presents to the clinic with a 1-year history of a progressive right tremor. She only notices the tremor when she is sitting still. On physical exam, you notice that her movements are not smooth, and she seems rigid in her extremities. She also demonstrates a slow, shuffling gait. This patient’s condition is most likely due to the loss of which neurotransmitter?
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?
An 18-year-old boy had an MRI performed after experiencing a first-time seizure shown below. What genetic disorder could be the cause of the abnormalities appreciated on imaging?
A 14-year-old male is evaluated in your clinic for seizures. Past medical history is significant for brief staring spells in elementary school. Now the patient is having generalized seizures especially when he is sleep-deprived. Additionally, the patient has recently been experiencing jerky movements of both arms in the morning, resulting in him dropping objects from his hands. An EEG shows generalized 4-6 Hz polyspike and wave discharges. What is the most likely diagnosis?