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A 68-year-old male with a 10-year history of Parkinson’s disease comes to the clinic for routine follow-up. He currently is taking levodopa/carbidopa, entacapone, and ropinirole. The patient is complaining of significant dyskinesias and unpredictable motor fluctuations between doses of levodopa/carbidopa. What is the most appropriate next best step in management?
A previously healthy 14-year-old female presents to the emergency room after experiencing a trip and fall where she hit her head. She returns to baseline, but out of caution a CT head and subsequent MRI brain are performed in the ED. What is a potential complication caused by this lesion seen in this MRI?
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?
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?
An 80-year-old female presents with abnormal eye movements and cognition. She has also been experiencing problems with gait and memory. An MRI of the brain revealed midbrain atrophy, with relative sparing of the other brainstem structures. Which of the following is the most likely diagnosis?
A 32-year-old Chinese male is referred to the epilepsy clinic after experiencing two episodes concerning for possible seizures. The first episode was unwitnessed, but the patient states that there was an abrupt loss of consciousness and that he woke up with the side of his tongue bitten and generalized myalgias. The second event was witnessed by his wife who noticed one day that the patient was unresponsive and lip-smacking for 2 minutes before returning back to baseline. MRI brain was performed and showed left-sided mesial temporal sclerosis. Which of the following medications should be avoided for this patient?
A 28-year-old male with a known history of neuromyelitis optica spectrum disorder (NMOSD) and a recent diagnosis of acute optic neuritis returns to the emergency room for worsening monocular vision loss despite completing 5 days of high dose (1 gm/day) methylprednisolone therapy. Based on the clinical scenario and level of evidence for efficacy, what is the most appropriate next step in therapy?
Which of the following clinical features is most suggestive of logopenic primary progressive aphasia?
Which of the following criteria for brain death based on EEG recording is incorrect?
A 74-year-old male with a past medical history of hypertension and hyperlipidemia is brought to the physician by his daughter who states that he has been exhibiting abnormal shaking of his hands and difficulty walking for the past year. On exam, the patient exhibits a shuffling gait, a tremor of his left hand at rest, and difficulty initiating movements. Which of the following is the most appropriate first-line therapy?
A 25-year-old woman with no significant medical history comes to the clinic for a routine physical exam. During the interview, she states that she is in a relationship with a famous singer for the last three months. She says his song lyrics are about her and his social media contains hidden messages that only she understands. The singer recently filed for a restraining order, but the patient says that’s “just for show.” She works at a local coffee shop and just recently got a promotion to manager. She denies any drug or alcohol use and takes no medications. Which of the following is the most likely diagnosis?
Which of the following arteries supplies the lumbar spinal cord?
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?
Which of the following arteries supplies the head of the caudate nucleus and the anterior limb of the internal capsule?
A 38-year-old man presents with a 1-year history of neck pain and left upper extremity weakness. The symptoms started insidiously, and have slowly worsened over time. A sagittal cervical spine MRI is shown below (Left: T2 without contrast. Right: T1 with contrast). Which of the following is the most likely cause of his symptoms?