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A 30-year-old male comes into the clinic with a 3-month history of scalp tenderness. His MRI brain is shown below (Left: T1, Middle: T2, Right: T1 with contrast). Which of the following is the most likely diagnosis?
Which of the following is not typically treated with indomethacin?
The lesion shown below (blue arrow) is most consistent with which of the following pathologies?
A 35-year-old female with a history of heroin abuse was found unresponsive and received 35 minutes of CPR before a return of spontaneous circulation (ROSC). She was intubated in the field and was brought urgently to the hospital. While in the ICU, the nursing staff noticed abnormal movements concerning for possible seizure. An EEG was performed and shown below. What is this finding most consistent with?
A 45-year-old female with a past medical history significant for asthma presents to the clinic for migraines with aura. Her headaches occur at least 13 times a month. She was given sumatriptan for abortive therapy six months ago but it has become ineffective. Her vital signs are stable. Her BMI is 33. Which of the following is the best next step in treatment?
A 28-year-old caucasian male was last seen well at 9:00 AM when he got into a verbal argument with his girlfriend. When the girlfriend returned from work at 5:00 PM, she found the patient on the floor of the garage altered, and states he “smelled unusual”. In the emergency department, the patient is disoriented but arousable with much effort. He complains of a headache and blurred vision, and he appears uncomfortable with a respiratory rate of 40. You send stat labs and they are listed below. What treatment should you administer immediately?
ABG: 7.18 pH, PCO2 = 28, PO2 = 118
Electrolytes: Na 135 mEq/L, K 5.0 mEq/L, Cl 105 mEq/L, HCO3 15 mEq/L
A 63-year-old woman with a history of right-sided breast cancer status post-mastectomy, chemotherapy, and radiation presents to your clinic with a 2 months history of right arm pain and paresthesias. Which of the following findings on EMG/NCS would most likely suggest a radiation-induced plexopathy over a recurrent neoplastic plexopathy?
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?
You are consulted to the psychiatric hospital to see a 48-year-old female with schizophrenia who has been under psychiatric care for 2 weeks after ingesting hundreds of pennies over a prolonged period. You are asked to address her new complaints of numbness in her feet and trouble walking. On exam, she had a broad-based gait and a positive Romberg. What could explain these findings?
Which of the following arteries provides the prominent supply to the posterior limb of the internal capsule?
This muscle biopsy is most consistent with which myopathic disease?
A 1-year-old female with a past medical history of iron deficiency anemia presents to your clinic with her mother for recurrent episodes of loss of consciousness. Her mother states that whenever she gets very agitated and starts crying, her lips turn blue and she will ”pass out.” She will then awaken after a few seconds. Her neurological exam is normal. Which of the following is the most likely cause of her episodes?
Which of the following is the most likely cause of the findings appreciated on the axial CT head shown below?
Which of the following muscles is innervated by the vagus nerve (CN X)?
Identify the lesion shown in the imaging below:
A 65-year-old man with a history of severe depression is bought to the clinic by his wife after losing 15 pounds in the last month. The patient states that he believes that his stomach and intestines have been removed and that he died several weeks ago. Which of the following is the most likely diagnosis?
A 12-year-old male is brought to the clinic accompanied by his father who states that for the past 4 months he has been randomly flailing his arm during class and calling out in the middle of the teacher’s lectures. He has been sent to the principal’s office twice in the past month for his disruptions. His father states that this is very out of character for him. In the clinic, the patient has intermittent movements of his right arm, where he raises his arm above his head and then slaps it down on his leg. Additionally, during the exam, he blurts out words that do not make contextual sense in the conversation. Two months later, the patient follows up with his father who states that all of the abnormal movements and vocalizations have resolved. What is the most likely diagnosis?
A 9-year-old boy with no significant past medical history was referred to get an EEG because of declining school performance and concern for staring vs. daydreaming episodes. Hyperventilation was performed and shown below. His EEG was otherwise unremarkable. Based on the available data which is the most appropriate next clinical step?
The electrographic pattern appreciated in the 6th second of this recording likely represents which of the following?
A 17-year-old female with a past medical history of anxiety, depression, and irritable bowel syndrome presents to the emergency room after a transient clinical episode. Her mother states that they were eating dinner when her daughter dropped to the floor and began having generalized shaking movements of her arms and her legs. She was unresponsive during the event and her eyes were closed. The event lasted approximately 30 seconds and there was no post-ictal confusion. In the emergency room, the patient has another event, where pelvic thrusting and asynchronous movements were appreciated for 2 minutes before resolution. The patient stated that she remembered having no control of her body during the event in question. Based on the most likely diagnosis, which of the following is the most appropriate treatment?
A 35-year-old female with a diagnosis of bipolar disorder is being seen in the clinic for the first time with a history of progressive difficulties walking. On examination, there was difficulty in fine motor movements and decreased arm swings with ambulation. A CT scan was performed and shown below. What is the most likely diagnosis?
A 46-year-old female presents to the clinic with complaints of recurring headaches. She states that she experiences episodes of sharp pain in her left cheek, which is exacerbated by eating or a cold wind blowing on her face. Outside of these triggers, she is largely pain-free. She doesn’t endorse any associated rhinorrhea, lacrimation, or facial flushing. Which of the following is the most appropriate treatment for her disease?
A 46-year-old male with a 2-month history of progressive headache and behavioral changes presents to the ED after experiencing a first-time seizure. An MRI was performed and shown below. A brain biopsy confirmed the diagnosis when it found pseudopalisading necrosis and microvascular proliferation. Which of the following treatment(s) is the standard of care for this patient?
A 24-year-old weight-lifter presents after sudden-onset neck pain. On exam, there is right eye ptosis and asymmetric right pupil constriction. Additionally, the patient appreciated decreased sweat production on the right side of his face. 1% hydroxyamphetamine eye drops are administered to the right eye and it dilates. Where is the most likely site of the patient’s lesion?
A 57-year-old man with a past medical history of bipolar disorder, atrial fibrillation, and type 2 diabetes presents to the clinic with complaints of a tremor. Symptoms have been present for years but they have not seemed to progress significantly over time. His current medications are warfarin, metformin, low-dose aspirin, and lithium. His neurological examination was unremarkable except for the presence of a fine, high-frequency tremor in his bilateral upper extremities. Based on the most likely diagnosis, what is the most appropriate next step in medical management?
Chronic exposure to which of the following medications can cause the pathology appreciated on the pathology slide below?
A two-month-old female presents to the clinic with her mother for episodes of abnormal posturing of her head, neck, and abdomen when breastfeeding. Her mother states that the episodes last approximately 30 seconds to 1 minute. Episodes are followed by crying. Her birth history was normal, and she has met all of her developmental milestones. Of the following, what is the best treatment for this patient’s condition?
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?
Patients with neurofibromatosis type 1 (NF1) classically have which of the following associated with their disease?
A 28-year-old woman with a history of intractable epilepsy presents to you for outpatient follow-up. She has been seizure-free on valproic acid and levetiracetam for the last 18 months. She reports a desire to become pregnant and asks if she has an increased risk of in-utero defects with her medications. Which of the following is the most appropriate answer to this question?
The usage of bupropion increases the risk of which of the following?
Per the American Academy of Neurology guidelines, which of the following diagnostic tests should be included in the routine evaluation of the demented patient?
Which of the following is an absolute contraindication for the use of tPA?
A 55-year-old male cigarette smoker with a past medical history of hypertension and medication non-compliance presents to the emergency room with an excruciating headache and altered mentation. An MRI of the brain is completed and provided below (T2 sequence). Which of the following is the most likely diagnosis?
A 6-month-old boy with no significant past medical history is brought to the clinic by his father because of abnormal limb movements that occur multiple times a day. His father describes high-frequency, low amplitude rhythmic movements that start in the child’s head and quickly spread down the shoulders. Episodes last approximately 1-2 seconds. There are no clear triggers and there is no loss of consciousness associated with the events. Family history is significant for essential tremor in the patient’s mother. Which of the following is the most likely diagnosis?
An 18-year-old male with a history of IV drug use was found unresponsive on a park bench by police. He was intubated by EMS and sent directly to the emergency room. The patient is comatose on examination. CT scan of the head is shown below. What is the likely diagnosis?
Which of the following issues in early development has occurred in the photograph below?
A 69-year-old man with HTN, CKD, HLD, tension headaches, and gout presents for 6 months of slowly progressive weakness. He has trouble rising from a chair without assistance and lifting objects above his head. On sensory exam, you note a bilateral symmetric loss of proprioception, vibration, and light touch in the feet and distal lower legs. He brings with him an EMG/NCS report from last week from an outside provider. It shows a length-dependent axonal neuropathy, as well as early recruitment and low amplitude action potentials on EMG of the proximal muscles. Serum CK is obtained and 3200. Which of the following is the most likely cause of his problem?
What is the mechanism of action of abciximab?
The abnormalities appreciated on the MRI below are due to a defect in which of the following processes?
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 24-year-old male with no known past medical history experienced a first-time generalized tonic-clonic seizure while at work. She is now in the emergency room and back to her neurological baseline. Bloodwork was unremarkable. A routine EEG and MRI of the brain were normal. Which is the most appropriate next step in management?
Which of the following is the mechanism of action of nimodipine?
Which of the following structures is well myelinated in a full-term (40-week) infant?
A 15-year-old male is brought to his primary care doctor by his parents because of learning difficulties in school. Examination revealed several pigmented skin lesions (see below). Which of the following additional findings may be present on examination?
What findings would be found on EMG/NCS in a patient who presents with a small fiber neuropathy?
Which answer correctly identifies all of the cranial nerve(s) that transverse through the structure (blue arrow) shown below?
Which of the following is the mechanism of action for natalizumab?
A 24-year-old man comes to the emergency room with severe left-hand pain after a fall at home. The patient refuses to allow the nurse or doctor to do a physical exam. A hand X-ray is unremarkable. She insists that all she needs is a note for two weeks of paid leave from her job. Which of the following is the most likely diagnosis?