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A 45-year-old man comes into the ED complaining of a severe headache. A spinal tap shows xanthochromia. The patient is treated immediately and spends the next two weeks in the neurocritical care unit. On day nine of his stay, his speech becomes slurred and the neurologist notices that the left side of his face is drooping. What is the class of drugs that could have potentially prevented these findings?
A patient with relapsing-remitting multiple sclerosis presents to the emergency department with a new headache, confusion, and vision loss. A T2 sequence from their MRI is shown below. Lumbar puncture is positive for JCV in the CSF. What is the mechanism of action of the disease-modifying therapy most likely to be attributed to this clinical scenario?
Which of the following blood vessels that supply the thalamus is the only one to branch off of the posterior communicating artery (PCOM) instead of the posterior cerebral artery (PCA)?
A 65-year-old female presents with complaints of hearing a strange “clicking sound” all of the time which started suddenly 6 weeks ago. On exam, you note a rhythmic tremor of the upper palate. The patient also has pendular horizontal nystagmus. Which MRI finding is most likely?
All of the following medications have Level A or B evidence in migraine prophylaxis except:
A 35-year-old male presented for sudden onset painless central vision loss. An outside hospital emergency room physician suggested he may have had a CRAO, but recommended immediate ophthalmology outpatient evaluation. The patient was unfortunately lost to follow-up for a few months. He presents today due to a sudden onset of central vision loss in the other eye.
On your ophthalmologic exam, you note hyperemic optic nerve and tortuous central retinal vessels, without evidence of vessel cutoff. He has a central scotoma bilaterally, with peripheral vision intact. He has red color desaturation as well. MRI brain w/ and w/o contrast with fat suppression and thin cuts through the orbits is performed, and normal.
This disorder is caused by which of the following pathologic processes?
A 33-year-old female presents to the clinic for evaluation of a left lower extremity foot drop. On physical examination, there is weakness in dorsiflexion. Ankle eversion, inversion, and plantar flexion strength are normal. Hip abduction strength is normal as well. Which of the following is the most likely etiology for the patient’s symptoms?
A 20-month-old female presents for regression of milestones. She was walking, and now crawls or refuses to move. The parents are concerned she may be having seizures because they notice she has intermittent jerks of the limbs and trunk, especially when she is startled. on physical exam, you note conjugate random darting of the eyes in vertical and horizontal directions. Tone, strength, and deep tendon reflexes are normal.
What test is most likely to identify the underlying etiology of this problem?
A 65-year-old male presents with an acute onset of back pain, bilateral lower extremity weakness, and bladder incontinence. A physical exam reveals decreased strength and loss of pain and temperature sensation in both legs. Vibratory and light touch sensation and proprioception remain intact. A lesion to which of the following arteries would most likely be responsible for this clinical presentation?
Which of the following is the mechanism of action of memantine?
A 50-year-old female presents with altered mental status. Her family states that over the past couple of weeks, the patient has had progressive memory loss, mood changes, and poor judgment. On examination, the patient has involuntary arm movements and an exaggerated startle response. Brain MRI, DWI sequence, is shown below. Which of the following is the most likely diagnosis?
This brain biopsy is representative of which of the following tumors?
A 64-year-old female with no significant past medical history presents to the clinic because of concerns related to her memory. She states that she has difficulty recalling names and recent conversations. She had a planned retirement two years ago and was functioning well at work at that time. She continues to live alone and is independent with her basic and instrumental daily life activities. Depression screening is negative, but she scores a 27/30 on the Montreal Cognitive Assessment (MOCA), with deficits in delayed recall. Her neurological examination is otherwise non-focal. What is the most likely diagnosis?
A 22-month-old girl presents with her mother for abnormal movements and loss of milestones. The mother describes the patient frequently and repetitively squeezes and twists her hands, and has lost some of her developmental milestones including fine motor skills and verbal speech. She has stopped walking as well. On examination of growth curves, her head circumference percentile appears to have fallen off of the curve. The patient has no other past medical problems, no past trauma, or past infections, and had been developing normally up until now. Of the following, which is most likely true?
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?
A 24-year-old woman presents to the ER with a one-day history of diplopia. On examination, the patient has right internuclear ophthalmoplegia. On further discussion, she describes an episode of left lower extremity numbness about 2 years ago that resolved after a few weeks on its own. An MRI of her brain and spinal cord was ordered. Findings included a T2 hyperintense contrast-enhancing lesion in the pons, as well as non-contrast enhancing T2 hyperintense lesions in periventricular and juxtacortical regions as well as in the thoracic spinal cord. What is the next step to confirm her diagnosis?
A 6-year-old female is seen in the clinic for decreased balance and numbness in her fingers and toes. Her father, who is with her at the clinic visit, states that she was developmentally normal until 2 years of age, at which time she began to have frequent falls. During the past year, she has also developed slurred speech. The neurological exam reveals truncal ataxia, ataxic gait, scanning speech, and decreased sensation to vibration and pinprick in her extremities. The ocular exam reveals irregular capillary dilation of the retina and skin. What is the most likely diagnosis?
You are interested in initiating tetrabenazine for a patient with refractory chorea. You should educate the patient that this medication carries a black box warning for which of the following?
Which of the following antiepileptic drugs can induce myoclonic seizures?
A 34-year-old female with a history of chronic daily headaches had an MRI performed as part of her workup. Her imaging is shown below. What is the likely etiology of the lesion shown?
While on the consult service you are called to see a patient from the surgical ICU whose hospital course has been complicated by a prolonged episode of ventricular tachycardia and hypoperfusion. After a return to spontaneous circulation, an MRI is performed due to concerns for ischemic stroke. MRI shows bilateral parietal-occipital hyperintensities on diffusion-weighted imaging consistent with watershed infarcts. Once he recovers from his cardiac event, what neurologic symptoms would you expect based on the MRI findings?
A 65-year-old female presents with a complaint of burning and tingling of her feet. Symptoms started in her toes two years ago and now extend up to her ankles. Neurological examination showed normal strength and intact sensation to light touch and vibration but an impaired sensation to pinprick in the first toes bilaterally. If performed, which of the following studies would likely be abnormal?
A patient with an AVM rupture is admitted to the ICU. On exam, the patient has abnormal neck, elbow, and knee extensor posturing, and wrist flexion. In which of the following locations was the AVM most likely located?
A 37-year-old man with a history of hypertension presents to the emergency department with a one-day history of difficulty walking. On examination, he has right leg paresis and hyperreflexia with a right-sided Babinski response. His non-contrast axial CT scan is shown below. Which of the following is the most likely etiology of this patient’s symptoms?
Based on the histopathologic findings shown below, how long ago did this patient experience an ischemic stroke?