Quiz 07/26/2022 (1)

A 47-year-old man with a history of bilateral cataract surgery at the age of 20 presents to the clinic for evaluation of progressive unsteadiness and cognitive decline. His father and older brother reportedly had similar symptoms in their early adulthood as well. On exam, there is notable dysmetria and gait ataxia. There were also abnormal soft-tissue masses appreciated near the Achilles tendons bilaterally. Which of the following is most likely to be abnormal in this patient blood?

Identify the pathologic finding marked by the red arrow.

A 69-year-old male presents to the clinic with his wife who states that for the past 10 months the patient has become increasingly slow and more clumsy with daily activities. He has also been complaining of dizziness, especially in the morning when he first gets out of bed and has fallen once in the past month. On physical exam, it is observed that the patient has a 21 mmHg drop in systolic blood pressure when going from a sitting to a standing position. A brain MRI is ordered and shows a cruciform hypointensity in the pons. What is the most likely diagnosis?

Which of the following findings is depicted in the vessel imaging shown?

What is the mechanism of action of apixaban?

A 75-year-old patient is brought in by her husband because of word-finding difficulty.  On cognitive testing, the most impressive finding was that the patient could not recall many colors of the rainbow. Based on this finding, what kind of memory is most impaired?

A 20-year-old female presents to the clinic with weakness and numbness in the right leg. She states that earlier in the day she was taking a long nap on her right side, and when she awoke, her entire leg felt like pins and needles. When she got up, she felt that she was dragging her right leg on the floor. She has had similar experiences in other limbs over the years but symptoms would slowly improve over weeks. Nerve conduction studies showed a right common peroneal nerve conduction block and mildly decreased conduction velocities of all nerves tested. Her mother reports that her father had similar episodes before he passed away from an unrelated illness. Which of the following is the most likely diagnosis?

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 7-year-old boy with a history of right facial port-wine stain and mild developmental delay presents to the emergency room for seizures. An MRI brain is performed and the T1 with contrast sequence is shown below. What is the most likely diagnosis?

A 67-year-old woman with a past medical history of osteoporosis, hypertension, bipolar disorder, and a remote right MCA stroke is referred to the epilepsy clinic after experiencing her first epileptic seizure. An EEG has shown right temporal epileptiform discharges. Which of the following medications are most appropriate to start as initial therapy?

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?

A 31-year-old man presents after being found down at the scene of an armed robbery. On physical examination, there is lower extremity weakness and loss of proprioception and vibration on the right side, as well as loss of pain and temperature sensation on the left leg. His MRI is shown below. Which is the most likely condition suffered by this man?

Which of the following findings is depicted in the vessel imaging shown?

What is the pathophysiology of the lesion provided below?

An 8-year-old male is seen in the clinic for difficulty paying attention at school and at home for the past 9 months. His mother reports that his elementary school teacher has called the home multiple times because the patient will often run around the classroom during assignments and frequently interrupts classmates. The mother states that at home, the patient has difficulty sitting still long enough to finish his dinner and homework. This patient’s condition is best treated with a medication that has what action?