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Which of the following structures is well myelinated in a full-term (40-week) infant?
A 15-year-old male comes to the clinic with his parents as they complain he has periods of the year where he will sleep up to 20 hours a day for multiple days in a row, as well as uninhibited eating and inappropriate sexual behavior. These episodes last for up to around 2 weeks at most, and then he is behaviorally back to normal in between episodes. Which is the most likely diagnosis?
Which of the following is the antibody associated with dermatomyositis that is known to confer the highest risk of cancer?
Which of the following direct dopamine agonists are the most effective in the management of severe “off” phenomenon related to chronic levodopa use in the management of advanced Parkinson’s disease?
A neurology consult is placed on a full-term newborn male after being delivered by an uncomplicated vaginal delivery with good APGAR scores. The physical exam reveals a midline lesion in his lumbar region. Based on the pathology shown below, which of the following would most likely also be present on head imaging?
Which of the findings are most likely to be found on examination in a patient with the lesion appreciated in the image below?
A 7-day-old infant is in the hospital since birth when he starts having seizures. He has been feeding poorly thus far. On examination, he has hypotonia, as well as distinctive facial features of midface hypoplasia, hypoplastic supraorbital ridges, and a prominent high forehead. The metabolic testing panel returns with elevated very-long-chain fatty acids. What is the physiology of this disorder?
Which of the following occurs at point “4” on this diagram of an action potential?
A 27-year-old female with a history of cataracts and an unknown family history was referred to the neurology clinic for excessive daytime sleepiness. On examination facial weakness and grip myotonia were appreciated. Genetic testing revealed a mutation in the DMPK gene. Based on her diagnosis, which of the following tests should be performed annually?
A 12-year-old boy with no significant past medical history is admitted to the neurology service after presenting with acute-onset fever, personality changes, and difficulties with speech. His mother states that three days ago he also reported seeing bats and other wild animals running around his room. She decided to bring him to the hospital today after she noticed that he seemed more tired and was moving slower than normal. A lumbar puncture and MRI of the brain are ordered. The CSF shows elevated protein, elevated lymphocyte and red blood cell counts, and normal glucose. MRI of the brain is shown below. What is the most likely diagnosis?
A 28-year-old female is brought to the emergency room by her husband because of behavioral changes and memory issues over the last 4 days. Right after the MRI, shown below, the patient had a tonic-clonic seizure. Based on the limited clinical history and imaging provided, which of the following is the most likely diagnosis?
A 50-year-old male farmer presents to the emergency department with diarrhea, steatorrhea, weight loss, abdominal pain, and joint pain in his shoulders and hips. He also displays constant rhythmic eye movements and repetitive facial muscle contractions. Intestinal biopsy reveals macrophage inclusions that positively stain with periodic acid-Schiff. What is the most likely etiology of this patient’s presentation?
A patient who was admitted to the neurology intensive care unit for myasthenic crisis developed ventilatory-associated pneumonia on the fifth day of his hospitalization. On the day following the initiation of antibiotic therapy, there was a significant decline in the patient’s respiratory status. Which of the following antibiotics most likely contributed to the patient’s respiratory distress?
A 54-year-old male with hypertension, hyperlipidemia, and atrial fibrillation on warfarin is newly diagnosed with epilepsy. Of the following medications, which is the most appropriate anti-seizure medication to prescribe?
A 2 month-old female is brought to the emergency room by her mother after she noticed abnormal movements concerning for possible seizure. The child was born at term and was the product of a normal pregnancy and delivery. While gathering a history, the child is lying on the bed still when you notice repetitive movements of his bilateral lower limbs. When her mother notices she picks up the patient and the movements resolve. What is the most likely diagnosis?
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 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 65-year-old female comes to the clinic complaining of weakness in his extremities. Symptoms are more prominent in the legs than in the arms. Oddly, when he tries to exert himself, he notes an improvement in his strength. Neurodiagnostic testing reveals low amplitude compound muscle action potentials (CMAPs) with an increase in amplitude on high frequency (50 Hz) rapid repetitive stimulation. Which of the following malignancies is most closely associated with this patient’s neurologic syndrome?
This muscle biopsy is most consistent with which myopathic disease?
A 34-year-old schoolteacher presents to the emergency department with confusion and weakness. Her family reports they have been staying at their cabin for labor day weekend and the patient spent the whole time inside complaining of generalized fatigue, myalgia, headache, and light sensitivity. They felt she had “a cold” so they let her rest. This morning, Monday, she was found in her bed unable to move and confused.
On exam, she is disoriented. She has nuchal rigidity. On musculoskeletal exam, she has diffuse but left > right weakness in the limbs. Her reflexes are 0/4 in the bilateral ankle, knee, and brachioradialis, and 1+ in the bilateral biceps. The sensory exam is normal.
The serum glucose is 100. Lumbar puncture is performed and shows glucose 60, protein 55, RBC 1, and WBC 25, lymphocyte-predominant.
Which of the following is the most appropriate preventive measure for this condition?