A 73yo woman found on the floor at home seems unaware of her ability to use her left upper and lower extremities. Although her left arm is flaccid at her side, she denies that there is anything wrong. When she is asked to raise the left upper extremity, she raises the right one. When the psychiatrist lifts her arm up and asks, "Whose arm is this?" she responds, "Yours." This type of behavior is most indicative of a lesion in the right:
Inferior Temporal Gyrus
Which of the following is characteristic of non-REM sleep?
Increased autonomic activity
Increased cerebral blood flow
Decreased recall of dream activity
The following recording obtained from a patient in an ICU is most consistent with which of the following?
A 19yo pt is evaluated for episodes of getting out of bed during the night and moving about the bedroom in a frenzied manner while asleep. The patient appears frightened during these episodes and has, on occasion, self-injured. Which of the following is typical for this sleep phenomenon?
Onset in childhood
Occurs during REM sleep
Organized activity is common
Eyes are closed during the episode
Associated with an increased risk of seizures
A 47yo patient develops new onset of vertigo, diplopia, gait imbalance and severe occipital pain during chiropractic manipulation of the neck. Which of the following is the most likely diagnosis?
Cervical disc herniation
Vertebral artery dissection
Small vessel occlusive disease
Which of the following tremors has a frequency of around 3 Hz, irregular amplitude and is most evident toward the end of reaching movements?
Which of the following is the molecular mechanism of action of ketamine?
Agonist at endamide receptors
Antagonist at serotonin 1A receptors
Partial agonist at kappa opiate receptors
Antagonist at N-methyl-D-aspartate receptors
Positive allosteric modulator of GABA receptors
Agonist at N-methyl-D-aspartate receptors
A patient with several days of fever and severe headaches is brought to the ER following a generalized seizure. The patient is confused, and tends to fall asleep easily. The family reports that the patient has been irritable and has complained of foul smells in the house. The figure displays the T2-weighted images obtained in the ED. Which of the following is the most likely diagnosis?
Progressive multifocal leukoencephalopathy
Which of the following neurotransmitters is predominantly inhibitory?
A 37yo patient who works as a truck driver presents with numbness of the left hand. The patient reports that the episodes of numbness have been increasing in frequency and severity over the last 2 years and the patient's grip has weakened. On examination, reduced pinprick sensation is noted on the patient's left little and ring fingers. The hypothenar muscles seem small. Which of the following most likely explains these findings?
Carotid artery stenosis
Ulnar nerve lesion
Median nerve entrapment
The sural nerve biopsy in an adult patient with Charcot Marie Tooth type 1 (perennial muscular atrophy) is shown below. On exam the patient exhibits diminished lower extremity DTRs and deformities of feet bilaterally. These deformities are typical of which of the following molecular abnormalities?
A 22yo obese woman presents with intermittent headache for the past several months. Neurologic exam is normal with the exception of bilateral papilledema on fundoscopic examination. MRI shows no structural abnormalities. An LP is performed in order to confirm the suspected diagnosis. Which of the following abnormalities of the spinal fluid is most likely to explain the patient's symptoms?
increased protein level
Tau staining of hippocampal tissue from a patient with progressive dementia is seen below. Which of the following is the most likely diagnosis?
A 40yo pt presents with new-onset of seizures characterized by bilateral thrashing movements of the arms and legs. Which of the following would suggest a non-epileptic etiology of these events?
Eyes remain open
A 25yo pt presents with new onset sz. On exam the patient has multiple brownish skin lesions, subcutaneous nodules and freckling of the axilla. Which of the following is the most likely diagnosis?
Sturge Weber syndrome
Neurofibromatosis type 1
Which of the following is characterized by a trinucleotide repeat expansion on genetic testing?
Amyotrophic lateral sclerosis
Charcot Marie Tooth Type 1A
Which of the following medications is most effective for migraine prophylaxis?
The diagnostic value associated with the presence of transient paresis of an arm or aphasia after an epileptic seizure is that it:
Indicates the etiology
Helps localize the focus
Indicates good prognosis
Helps in the selection of treatment
Which of the following is the principal mechanism of termination of the synaptic activity of dopamine in the pre-frontal cortex?
Repute by dopamine transporter
Degradation by monoamine oxidase
Diffusion away from the synaptic cleft
Degradation by catechol-o-methyl transferase
A 56yo pt w/DM and HTN who smokes complains of the acute onset of vertigo, nausea, vomiting and unsteady gait. Examination shows decreased sensation to pinprick in the left side of the face, ataxia of the left upper and lower extremities, nystagmus and hoarseness. As the patient walks, they veer to the left. The most likely diagnosis is:
Lateral Medullary stroke
Which of the following best describes the interaction between valproic acid and lamotrigine resulting in an increased risk of severe dermatological reactions?
Valproic acid inhibits glucurodination of lamotrigine
Lamotrigine reduces renal excretion of valproic acid
Valproic acid displaces lamotrigine from protein binding
Lamotrigine promotes cytochrome P450 metabolism of valproic acid
A 42yo pt c/o pain in the R neck. When distracted the pt has a tendency to rotate the neck to the left. The pt reports being able to prevent the deviation of the head by touching the chin. Examination is normal except for some spasm of the neck muscles, particularly the right SCM. The treatment of choice would be:
The presence of conduction block on a nerve conduction study indicates which of the following?
Increased amplitude of action potentials
The most common severe complication of temporal arteritis is caused by occlusion of the:
internal carotid artery
The photograph of the midbrain shown below on the left demonstrates the findings from a patient with which of the following conditions, of note, normal midbrain shown for reference on the right?
An 80yo male is evaluated for gait imbalance and falls. The patient's spouse reports that her husband has episodes of screaming and kicking while asleep and he describes vivid dreams of being chased. He complains of not feeling well rested after a night's sleep. The patient is at highest risk of having or developing which of the following conditions?
Myotonic Muscular Dystrophy
Amyotrophic lateral sclerosis (ALS)
A 75yo pt is evaluated fro progressive gait imbalance, urinary incontinence and cognitive decline. After removal of CSF there is noticeable improvement in gait and balance. CT of the patient's brain obtained before LP would likely show which of the following?
Enlargement of the frontal horns
Hypodensity in the left hemisphere
Increased intensity in the basal ganglia
Crescent shaped hyperintensity over the right hemisphere
Which of the following is the most effective treatment for acute migraine?
The lesions in the brain cut shown below are most consistent with which of the following clinical presentations?
The diagnosis of myasthenia graves can frequently be established by measuring antibodies against which of the following proteins?
Which of the following cancers/malignancies has the highest likelihood of metastasizing to the brain?
A 37yo patient was in a motor vehicle accident after falling asleep while driving. The patient's spouse reports the patient has frequent episodes of falling asleep while eating, dining, watching tv or conversing. Which of the following laboratory findings is likely to be found?
Increased serum melatonin
Decreased CSF hypocretin
Increased CSF protein
Decreased serum ferritin
Increased serum glucose
A 17yo pt experiences a 2mth period of decreased energy and drowsiness associated with increased sleep duration, which progresses to 18hrs or more a day. This pattern is interrupted only by toileting and eating, which is increased. The patient appears to be dull, confused and socially withdrawn. The sleep EEG shows that NREM and REM cycles are normal, except for increased duration of sleep. Which of the following is the most likely diagnosis?
The clock drawing in the image below is consistent with a lesion in which of the following areas of the brain?
Nonfluent, effortful speech with decreased speech output is most often associated with lesions of which of the following cortical structures?
Inferior frontal gyrus
Superior temporal gyrus
Which of the following immunomodulators is associated with increased risk of significant depression in patients with cancer?
A patient develops progressive weakness over several days. Examination reveals an absence of reflexes and muscular weakness that is more prominent in the lower extremities than in the upper extremities. Nerve conduction studies show slow conduction velocity, prolonged distal motor latency and conduction block. The most likely diagnosis is:
Acute inflammatory polyneuropathy
Acute exacerbation of multiple sclerosis
Contralateral leg weakness with sparing of the face and arm associated with urinary incontinence and abulia are typical for stroke in the territory of which of the following arteries?
In the examination of a 32yo woman with vertigo and diplopia, it is found that when she looks to the left she has nystagmus on the left eye only, with failure of adduction of the right eye. This disorder of ocular motility suggests the diagnosis of:
Diabetic 6th nerve palsy
Progressive supranuclear palsy
An IV methamphetamine user develops severe back pain, followed after several days by bilateral lower extremity weakness, lower extremity sensory loss and bladder incontinence. Physical examination reveals a low-grade fever, tenderness to percussion over the second and third lumbar vertebrae, paraparesis and loss of sensation to light touch and pinprick in both legs, buttocks and the sacral region. Which of the following is the most likely explanation for this presentation?
Spinal cord ischemia
Spinal epidural abscess
Tropical spastic paraparesis
Subacute necrotizing myelitis
A 45yo woman is evaluated for episodes of her arm feeling "like it is falling asleep" in the night. The patient describes pins and needles of the hand during the night and upon awakening. Which of the following is the most likely cause of the patient's symptoms?
Carpal tunnel syndrome
Guillain Barre syndrome
Tranisent Ischemic Attack (TIA)
A 6yo child has brief episodes of staring lasting a few seconds. Rhythmic, fast and fine blinking movements occur during these episodes. Which of the following medications would be most appropriate to treat this child's condition?