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A 26-year-old woman presents to the emergency department with third-degree burns covering the entire palmar aspect of her right hand. She claims that she was cooking dinner and touched the stove, but states that she “didn’t notice it was hot”. On neurologic exam, she is unable to distinguish between hot and cold sensations on her hands, arms, shoulders, chest, and back. She also fails to respond to pinprick sensation in the same distribution. She denies any major recent traumatic injuries. Which of the following is the most likely cause of her symptoms?
A 68-year-old man presents with word-finding difficulties and speech hesitancy. His wife notices that he struggles to name objects and sometimes mispronounces words. On examination, he can name objects but has significant difficulty repeating long sentences. While his spontaneous speech is slow, it is grammatically correct. Which of the following is the most likely diagnosis.
A 55-year-old male presents with progressive worsening new headache over several months. He did not wish to seek medical attention but now presents because his family reports his facial expressions “look different”. On exam, he has impaired upgaze, light near dissociation, and convergence retraction nystagmus. An MRI is done and shows a lesion. Where is the lesion likely located?
A 9-year-old boy presents with his mother for 18 months of multiple complaints. He reports having continuous thoughts of needing to wash his hands and building anxiety until he can perform the action. He spends more than an hour in total every day washing his hands. He also has stereotyped movements on exam with head turning and shoulder shrug, and will sometimes shout random words. Lab and imaging workup is negative. Which of the following medications, paired with cognitive behavioral therapy, is most indicated?
A 6-month-old male is admitted to the ED for acute respiratory failure. On examination, he has generalized weakness, diffuse hypotonia, and areflexia. He was admitted to the pediatric Intensive Care Unit and intubated. A chest X-ray showed a narrow chest. EMG/NCS was performed showing axonal motor polyneuropathy with tongue fasciculations and signs of chronic denervation. What is the most likely pathologic etiology causing this presentation?
A 68-year-old female presents to your clinic with the chief complaint of daytime somnolence. She endorses an unpleasant feeling in her lower extremities while trying to go to bed which prevents her from sleeping. Moving her limbs gives transient relief. What is the most appropriate first diagnostic test?
A 75-year-old patient is brought by her husband because of word-finding difficulty. On cognitive testing, the most impressive finding was that the patient couldn’t recall many colors of the rainbow. Based on this finding, what kind of memory is most impaired?
Which of the following findings is depicted in the catheter angiogram shown?
An 18-year-old male presents to the ED after having his first generalized tonic-clonic seizure. MRI was unremarkable but a routine EEG showed 4-6 Hz polyspike and wave discharges in sleep. Which of the following antiepileptic drugs are most appropriate to start based on the available information?
A 40-year-old man from Honduras presents to the emergency room after experiencing a first-time seizure. CT head showed multiple calcified intraparenchymal lesions. Physical examination in the emergency room was unremarkable except for the presence of multiple subcutaneous nodules. A biopsy of one of these nodules was completed and microscopic imaging of the lesion is shown below. What is the most likely diagnosis?
Which of the following antiepileptic drugs can induce myoclonic seizures?
A 17-month male was brought to the pediatric neurology clinic was brought to the clinic with concerns for developmental delay. Parents note that the child was a product of a normal pregnancy and his delivery was uncomplicated. A developmental delay was appreciated by 8 months of age. He is largely non-verbal. He appears happy in the room, laughing spontaneously without any external stimuli. Which of the following abnormalities most likely explains this developmental disorder?
A 65-year-old female patient presents with right homonymous hemianopsia for the past week. She also says she has difficulty reading but no problems with writing. Which of the following area of the brain is likely affected?
A 45-year-old man with a past medical history of cardiac arrhythmia requiring pacemaker placement is referred to the clinic with a twenty-five-year history of slowly-progressive bilateral ptosis and diplopia. On examination, he has bilateral ptosis, decreased range of motion of the extraocular muscles, and mild proximal weakness in his upper and lower extremities. Which of the following is the most likely diagnosis?
The medulla is an embryologic derivative of which of the following structures?
A patient with a recent history of ischemic stroke with almost no residual focal deficits except for a mild right-sided facial droop presents to the emergency room with altered mental status. Vital signs are only impressive for a low-grade fever. CT head and CTA show no acute changes when compared to imaging completed for his initial stroke. Blood work shows thrombocytopenia, anemia, and renal failure. A severe drug reaction is suspected. Which of the following medications is most likely the cause of this clinical presentation?
An MRI brain is ordered for a 6-month-old male with failure to thrive, dystonia, and regression of developmental milestones. The T2 axial images are shown below. Which of the following is most likely the diagnosis?
A 63-year-old female presents with a 6-month history of difficulty walking and muscle weakness. Neurologic examination reveals normal bulk but muscle fasciculations, bilateral extensor plantar responses, muscle spasticity, and hyperreflexia. Pathology at which of the following structures could explain these symptoms?
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?
A 40-year-old with AIDs (CD4 count 60) presents to the emergency room with a 2-month history of progressive headache, confusion, and left sided weakness. MRI brain with and without contrast was performed and it showed ring-enhancing lesions in the basal ganglia and the right frontal lobe. A brain biopsy was performed and shown below. Which is the most likely diagnosis?
A 57-year-old male with an unknown past medical history who recently immigrated from South Asia presents to the emergency department with new-onset skin lesions on his arms. On physical exam, the patient has two large, erythematous lesions with a clearly demarcated but flat border. The nerves around these lesions appear thickened. Biopsy of the lesions shows epithelioid cell granulomas and few bacteria. What is the most likely diagnosis?
A 20-year-old male presents with severe burns on his hands after accidentally touching a stove. Neurology was consulted because the family noted that the patient did not initially pull away from the hot stove as one would expect. Physical exam shows decreased sensation of pain and temperature along the back and arms, with intact strength. T2 sagittal MRI of the cervical spine is shown below. Which of the following is commonly associated with the pathology shown?
A 30-year-old male presents to the clinic with a fifteen-year history of progressive weakness and sensory loss in his lower extremities. Examination shows hammertoes, high arches on his feet, 4/5 ankle dorsiflexion strength, and a mild decrease in sensation to pinprick in the 1st toes bilaterally. Upon questioning he mentions that his father had similar-looking feet and started to use a cane in his fifties. Which of the following genetic mutations may be the cause of the patient’s symptoms?
A newborn male is evaluated in the NICU for a lesion on his lower back. He was born to a mother with no prenatal care at 37 weeks gestation. Imaging of his lower back shows the meninges and spinal cord herniated through the defect, covered in a membrane. His condition could have most likely been prevented through prenatal supplemental with what?
Which of the following medications has been shown to improve neurological outcomes in patients with subarachnoid hemorrhage?
A 13-year-old girl presents with headache, confusion, and polyuria. MRI brain with contrast shows a heterogeneous, contrast-enhancing lesion with mass effect located in the pineal region. A biopsy was performed. Immunohistochemical staining for cKIT of the biopsied tissue is shown below. Which of the following is the most likely diagnosis?
A 32-year-old man was recently admitted to the stroke service for an intracranial hemorrhage secondary to an arteriovenous malformation. In addition to his acute focal neurological deficits, the following skin lesions are appreciated (see image below). A genetic syndrome is suspected. Based on the most likely clinical diagnosis, what is the risk of his son having the same condition?
A 42-year-old female with a history of epilepsy has an EEG performed while establishing care with a new provider. She admits to knowing very little about what type of epilepsy she has. A 10-second epoch of her study is shown below. Based on the available data, what medication should be avoided in the management of her epilepsy?
A 21-year-old female was admitted to the hospital with a 3 weeks history of progressive lower extremity weakness. An EMG was performed and the results were shown below. Based on the clinical history, examination, and diagnostic testing, the patient was started on plasma exchange (PLEX) therapy. After completing her PLEX therapy there was a marked improvement in her weakness. Although not shown below, which of the following additional NCS/EMG results were also likely present on the day of recording?
A 78-year-old patient with a history of multiple system atrophy (MSA) presents to your clinic for falls. The patient states that while standing he initially experiences feelings of lightheadedness and tunnel vision before a loss of consciousness. While on the ground he will be “twitching” for 30 seconds before he regains consciousness. Which of the following tests is the most likely to be diagnostic in this case?
Which of the following regions of the brain, when active, promotes the switch from drowsiness to non-REM sleep?
A 38-year-old man presents with frequent headaches over the past year and recent development of polydipsia and polyuria. He has also been complaining of a dry cough, shortness of breath, and erythematous nodules along his shins bilaterally. MRI of the brain shows a contrast-enhancing lesion of the hypothalamus. Which of the following is the most likely diagnosis?
Which of the following can not passively diffuse across the blood-brain barrier?
Which of the following autoantibodies are associated with myasthenia gravis?
A 45-year-old patient presents with complaints of new-onset double vision. On the general neurologic exam, you note the patient tilts their head to the left. The remainder of the physical exam is unremarkable. Which of the following is the most common underlying pathologic cause of this issue?
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 37-year-old female with a past medical history of obesity presented to the emergency room with a severe headache and visual disturbances. The funduscopic exam shows bilateral papilledema. An MRI of the brain shows an empty sella and MRV was normal. A lumbar puncture was performed. The opening pressure was 38 and there were no WBCs or RBCs appreciated in the CSF. What is the most appropriate therapy for her disease?
A 38-year-old man with a past medical history of chronic cough, and shortness of breath presents with a three-week history of recurrent headaches, confusion, and difficulty with speech. On exam, there are difficulties with attention and mild aphasia. Additionally, there appear to be erythematous nodules along his shins bilaterally. Brain MRI shows a contrast-enhancing lesion in the left hemisphere. Due to the patient’s chronic pulmonary complaints, a chest X-ray is also performed. Which of the following is most likely seen on a chest X-ray?
An 80-year-old woman with a history of Parkinson’s disease that is well controlled with carbidopa-levodopa presents with her husband for evaluation of delusions. Her husband states that the patient believes that she is being consistently monitored by the FBI and will avoid eating certain foods for fear of being poisoned. She is also constantly worried that her husband will leave her for a younger woman. Which of the following medications would be the most appropriate FDA-approved treatment for these symptoms?
An 82-year-old female patient with a history of atrial fibrillation is brought to the emergency department after being found down at home. She is unable to move her extremities, although she is able to blink and move her eyes vertically. Occlusion of which artery/arteries is the most likely cause of her symptoms?
Which of the following is the mechanism of action of riluzole?
A 66-year-old male presents to the emergency room as an unrestrained driver in a motor vehicle accident. While initially only complaining of mild neck pain, within 30 minutes of the collision he started to experience bilateral numbness in his hands and significant symmetric upper limb weakness. Soon thereafter, the weakness extended down to his lower extremities. Neurologic examination is remarkable for loss of pain and temperature sensation in his bilateral upper extremities and symmetric bilateral upper extremity greater than lower extremity weakness. Which of the following is the most likely diagnosis?
A 50-year-old male with a 1-year history of behavioral changes and abnormal movements has a CT head performed after having a fall at his nursing home. Based on the imaging and brief clinical history what is the likely genetic abnormality associated with his neurological disease?
A patient with Alzheimer’s disease donates their brain for research on neurodegenerative disease. A histopathologic, H&E-stained, sample of his brain tissue is shown below. What is the structure marked by the black arrow?
A 14-year-old male is referred to the neurology clinic by his PCP with the complaint of bilateral hearing loss. Neurological examination shows a sensorineural hearing loss. Multiple hyperpigmented lesions on the chest and back were also appreciated. An MRI of the brain was ordered that showed bilateral posterior fossa lesions. Genetic testing would reveal a mutation on which chromosome?
A 45-year-old female with a recent diagnosis of multiple sclerosis, based on MRI and CSF analysis, is referred to your clinic to discuss possible disease-modifying therapies. You review the clinical history with her and she states that for the past 18 months she has experienced progressive right upper and lower extremity weakness. She denies any periods of transient improvement or dramatic worsening of symptoms. Based on this clinical history, what is the most appropriate disease-modifying therapy for this patient?
A 57-year-old male with recently diagnosed small cell lung cancer (SCLC) is presenting to the electromyography lab with a one-month history of muscle cramps and muscle pain. Percussive myotonia is appreciated on examination. Electromyography showed myokymic discharges. Autoantibodies against which of the following channels are likely present in this case?
Which of the following is the most appropriate pharmacologic agent for type II episodic ataxia?
Which of the following is the best prognostic finding on EEG after cardiac arrest?
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?