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A 33-year-old patient presents in the clinic for evaluation of bilateral leg weakness, and urinary incontinence. He first started noticing right leg weakness about 2 years ago and then a few months later felt similar symptoms developing in his left foot. These symptoms gradually worsened over time to the point that he had to start using a cane because of frequent falls. Imaging of the whole neuroaxis was performed. MRI of the brain showed several periventricular and juxtacortical T2 hyperintensities with no enhancement. A lumbar puncture was performed and it had unique CSF oligoclonal bands. What is the most likely diagnosis?
A 24-year-old patient had a severe unhelmeted motorcycle accident and despite best efforts by medication providers, he passed away two days later. An autopsy was performed. Identify the structure marked by the white arrow.
A 38-year-old female presents for 5 weeks of worsening encephalopathy, and blurred vision. An MRI Brain with contrast is performed and shown below (T1 post-contrast, multiple axial sections). Of the following, what is the most likely diagnosis?
A 36-year-old man with no significant past medical history presents with lower back pain, lower extremity weakness, and urinary incontinence. A non-contrast enhancing lesion was found on lumbar MRI (T1 sequence without contrast image shown below). What is the most likely diagnosis?
You are evaluating a patient in the clinic for loss of light touch, pain, and body position in the left upper and lower limbs. Within which of the following thalamic nuclei do these signals synapse to third-order neurons?
A patient with a past medical history of Parkinson’s disease is brought to the emergency room with the chief complaint of a severe headache, chest pain, and shortness of breath. His blood pressure on arrival was 196/122 mmHg. The patient states that he was in his usual state of health earlier in the day but started feeling unwell after attending a wine and cheese pairing event at a local winery. Which of the following medications is likely the cause of the patient’s symptoms?
A 65-year-old man presents to the emergency room with progressive weakness over the course of several months. Examination shows pure motor weakness with no sensory involvement, decreased reflexes, and diffuse fasciculations. An EMG shows a conduction block of motor neurons outside of compression sites and normal sensory conduction velocities. Which of the following of most appropriate for treatment?
A 16-year-old male is brought to the emergency room by his parents for generalized weakness. The patient states that he woke up in the morning that day with flaccid paralysis of his arms and legs which was so significant that he couldn’t get out of bed. In typical teenage boy fashion, he wasn’t very worried about this at the time and went back to bed. It wasn’t until 4 hours later when he woke up again with the same degree of weakness that he became concerned and screamed for his parents to help. The patient denies any recent drug or alcohol use. The only interesting thing from the previous night was that he partook in and won a pizza-eating contest with his friends. The patient’s father admits to having had similar episodes to this when he was younger. If the patient’s symptoms are due to a genetic disorder, a mutation in which of the following genes is most likely responsible?
A 30-year-old woman with well-controlled epilepsy with lamotrigine monotherapy comes to the clinic today stating that she and her husband are planning to start a family. Which of the following statements is most correct regarding her clinical situation?
What is the mechanism of action of clopidogrel?
Stevens-Johnson syndrome associated with carbamazepine use is more likely in patients with which of the following HLA alleles?
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 identifies the straight sinus?
A 90-year-old woman presents to the emergency room with an acute change in mental status. On examination, she is alert but is not answering questions or following commands. Speech is fluent, but not interpretable. Comprehension is severely impaired. Interestingly she was able to repeat full sentences without much difficulty. Which of the following is the most likely territory of ischemic damage?