Quiz 07/21/2022 (1)

This muscle biopsy is most consistent with which myopathic disease?

A 37-year-old woman with a history of chronic alcoholism and amphetamine abuse presents to the ED with a 36-hour history of recurrent hematemesis and abdominal pain. She had no detectible ethanol levels in her blood on arrival. In the ED she complains of double vision and is started on intravenous fluid replacement. Two hours later the patient begins to develop ataxia and becomes progressively disoriented. The patient’s rapid deterioration is most likely due to which condition?

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 37-year-old female presents to the emergency room with diplopia and ambulation issues. Other than having an upper respiratory tract infection two weeks ago, there is no other significant past medical history. On physical exam, the patient has a decreased range of motion of the extraocular muscles bilaterally, diffuse areflexia, and marked dysmetria on finger-to-nose and alternating movements testing. Which of the following autoantibodies is most likely associated with this disease?

A 31-year-old female with depression, anxiety, and migraines presents to the ED for altered mentation. On arrival, she has a temperature of 41 degrees Celcius, HR 130, and a systolic blood pressure of 190. On exam, she is diaphoretic and agitated, with increased tone, hyperreflexia, shivering, and dilated pupils.

You call her family who states that the patient has a hard time keeping down a job, frequently moving from state to state. She has had a number of different psychiatrists over the years, and you, therefore, are unable to find a comprehensive medication list. In her purse, she has a pill bottle of sertraline, with 85/90 pills remaining.

Which of the following other medications is this patient likely taking?

Neural tube defects will develop at which point in fetal development?

A 67-year-old male wakes up with a painful, right-sided, itchy rash coming across his abdomen like a band involving the umbilicus. His primary care provider is concerned that the patient has shingles. For this patient, re-activation of the varicella-zoster virus occurred at the dorsal root ganglion at which thoracic level?

A 14-year-old girl with no significant past medical history is brought to the clinic with a 1-week history of involuntary movements of the left side of her body. Her mother reports that 1 month ago, she experienced a week of fever, malaise, and fatigue, but they did not seek medical treatment at the time. On physical exam, the patient exhibits involuntary, irregular movements of her neck, left arm, and left leg, and generalized hypotonia. What is the most likely diagnosis?

A 56-year-old male with a past medical history of smoking presents to the clinic with the chief complaint of a 1-month history of progressive muscle weakness. Interestingly, he notes that his strength seems to improve with repeated use. The physical examination is notable for proximal muscle weakness of the bilateral lower extremities and areflexia in all extremities. Serology and electrodiagnostic testing confirm the diagnosis. What is the first-line therapy for symptomatic management?

The usage of bupropion increases the risk of which of the following?