Quiz 07/25/2022 (3)

A 67-year-old woman suffers from sustained involuntary contraction causing her head to be forcibly turned to the right and significant discomfort. On exam, her left sternocleidomastoid is significantly hypertrophied. She receives treatment with Botulism Toxin A. Subtype A of botulism toxin acts to reduce synaptic action of acetylcholine by what mechanism?

A 24-year-old male presents to the clinic with numbness in the hands and feet. He has been experiencing these symptoms since his late teens, but the numbness has gotten progressively worse. Additionally, he has been stumbling and losing his balance more frequently in the past 18 months, and he received a new pair of glasses because he was having trouble with his vision at night. On physical exam, he has decreased sensation to vibration and pinprick in his bilateral lower extremities and palpable, enlarged nerves. Laboratory studies reveal an elevated level of phytanic acid. What is the most likely diagnosis?

Which of the following does this EEG tracing reveal?

A 25-year-old female presents with anisocoria; her right eye is significantly more dilated when compared to the left eye in ambient light. The right pupil is also irregular in shape, does not respond to light, and is sluggish to constrict to near accommodation. When dilute pilocarpine (0.125%) is administered to the right pupil it constricts but the left eye doesn’t react at all.

Which of the following is the most likely cause of the patients’ symptoms?

A patient with newly-diagnosed early state amyotrophic lateralized sclerosis (ALS) presents to your multidisciplinary clinic for the first time. After discussing the effectiveness and side effects of riluzole and endavarone, the patient informs you that he doesn’t want to start either medication. Which of the following basic principles of medical ethics could be best applied to this scenario?

A 78-year-old male with a past medical history of depression and chronic alcohol use presents to the clinic with his wife for evaluation of a tremor. He states that the tremor is most severe at rest and disappears with purposeful movement. His wife states that he has been having slower movements over the past year. On physical exam, a “pill-rolling” resting tremor is noted in his left hand and the patient has difficulty with gait initiation and takes short steps when walking forward. Which dopaminergic pathway is most likely affected in this patient?

Which of the following headaches is most likely to respond to a combination of caffeine and lithium?

A 12-day-old male is brought to the pediatrician by his mother with a two-day history of rash. The child was born full-term to a G2P2 mother with good APGAR scores. On physical exam, the pediatrician notes that the child has a pink, crusting, maculopapular rash over his buttocks, thighs, and soles of his feet. She states that a week after his birth he had the “sniffles” and a lot of white discharge from his nose. On exam, there is hepatomegaly and generalized lymphadenopathy. Which of the following is the most likely cause of the patient’s symptoms?

A 30-year-old female with no known past medical history comes to the emergency room after a generalized tonic-clonic seizure. Her friend says that she has been behaving oddly over the past couple of days and has been complaining of a headache. An axial T2 brain MRI is shown below. Which of the following is the most likely diagnosis?

A 56-year-old male comes to the clinic with a burning and tingling sensation in his feet and hands for the past 4 months. He has a history of morbid obesity and underwent gastric bypass surgery last year. On physical exam, he has 3+ ankle and patellar reflexes. He also has a positive Babinski and positive Romberg sign. There is impaired position and vibration sense in his big toe bilaterally. This patient’s condition is most likely due to a deficiency of which of the following?