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Which of the following is most likely to cause the pathology seen in the image below (white arrow)?
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 38-year-old woman with a history of gastric bypass begins taking over-the-counter supplements that are intended to promote hair and nail health. After several months, she begins to experience paresthesias in her legs and has several falls. She is referred to a neurologist. On examination, she is noted to have non-length-dependent severe loss of vibration sensation in her legs, loss of pain and temperature distally in a length-dependent pattern, and spastic tone with hyperreflexia in her lower extremities. Additionally, her gait is wide-based and a Romberg’s sign is positive. Which of the following treatments is most likely to prevent further neurologic deterioration?
The imaging shown below is most consistent with which of the following diseases?
A 45-year-old patient presented to the emergency room unresponsive. Emergency medical services noted that the patient was found in his garage with the car running in an apparent suicide attempt. Despite appropriate medical care, the patient passed away. An autopsy was performed. A gross pathology image is shown below. Identify the following regions marked by the white arrows.
A 65-year-old woman with a past medical history of hypertension presents with recent onset of bilateral eye discomfort and diplopia. She states that she is unable to completely close her eyes. On exam, pain is elicited when testing extraocular movements. Visual acuity and visual fields are unremarkable. MRI of the brain reveals excessive peri-orbital subcutaneous tissue bilaterally. Which of the following is the most likely diagnosis?
A 33-year-old industrial worker presents to the ED complaining of sudden onset nausea, bilateral headache, dyspnea, confusion, and eye irritation. His skin is flushed on physical exam. He states he forgot to wear protective equipment (mask, gloves) while working. A T2 flair MRI of the brain is shown. Exposure to which of the following substances is likely?
A 62-year-old woman with a history of rheumatoid arthritis presents with insidious onset of painless proximal muscle weakness and atrophy. A serum CK is obtained and is normal. TSH is also normal. Her medication list includes lisinopril, aspirin, and prednisone. EMG shows short-duration motor unit potentials in the deltoids and quadriceps bilaterally. A muscle biopsy is performed. Which of the following will most likely be appreciated?
A 4-year-old boy is brought to the pediatric neurology clinic with 4 months history of progressive dysarthria, ataxia, and abnormal limb movements. His mother says that the patient’s right side of the mouth seems to be pulled to the right and his left arm always seems to be pulled up towards his chest. An MRI was performed and shown below. What is the likely diagnosis?
A 6-year-old patient presents with a decline in neurologic function with ataxia, optic atrophy, spastic tetraparesis, and cognitive decline. MRI shows diffuse white matter demyelination with sparing of the U fibers. Which of the following laboratory tests is most likely to diagnose this problem?
You are caring for a 1-month-old infant in the neonatal ICU with abnormal movements since birth. The baby is seen writhing in bed, with her arms and legs and axial trunk moving in a snake-like pattern. A CT head is done and shows bilateral cystic lesions on the basal ganglia. Toxic levels of which of the following are most likely at play?
A 40-year-old textile worker is brought to the clinic for slowly progressive symptoms including shuffling gait, tremor, and profuse drooling. On examination, his speech is difficult to understand and there is cogwheel rigidity in his arms and legs. His tremor is most evident when his limbs are at rest. Exposure to which of the following is the most likely cause of the patients’ symptoms?
Metachromatic leukodystrophy is due to a deficiency of which of the following enzymes?
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?
A 37-year-old woman with a history of chronic alcoholism and amphetamine abuse presents to the ED with a 36-hour history of recurrent hematemesis and abdominal pain. She had no detectible ethanol levels in her blood on arrival. In the ED she complains of double vision and is started on intravenous fluid replacement. Two hours later the patient begins to develop ataxia and becomes progressively disoriented. The patient’s rapid deterioration is most likely due to which condition?