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Which symptom of epilepsy is most commonly associated with a focus in the temporal lobes?



A 70 year old black female has the abrupt onset of right-sided weakness affecting the face and arms. MRI is consistent with an infarct in the territory of the middle cerebral artery. Microscopic examination of the patient´s brain demonstrates liquefied tissue without preservation of cell outlines. The process underlying this pathologic appearance is which one of the following?



A 34 year old female presents with diplopia, muscle weakness after exercise, dysphagia, and dysarthria. On exam she has ptosis and proximal limb weakness. Her dysphagia becomes progressively more severe over the course of several weeks. The diagnosis can be confirmed by which one of the following?



Which one of the following is the newest treatment of choice for multiple sclerosis?



A 37-year-old woman has developed left-eye visual loss over the past 3 days. She has pain upon movement of the eye. No other relevant history exists. The examination shows central scotoma, marked loss of color vision, and an afferent papillary defect, and the optic disc is swollen with a flame-shaped hemorrhage present. Which of the following tests is most appropriate to order at this time?



A 69-year-old has become increasingly forgetful over the last few months. He does not remember where he puts things and often forgets to feed his dogs. Last week, he lost his way back home. He also forgets the names of people he has known for several years. He has not been wearing clean by DealXplorer" href="http://s.igmhb.com/click?v=SU46MTMwMDUxOjIxOTIyOmNsb3RoZXM6MjFhZTg0MmE3Njg0N2UxNGRjY2YyYTU4MmVhOGJkMjk6ei0yMzAxLTUwMDMzMDYwOnd3dy5pbnRlcmZhY2UuZWR1LnBrOjM3OTU5ODowOjg1ODk4OGMzMjk5YTQ5NmVhZjVjZGY2ZWQ0MmJiYjFkOjA6ZGF0YV9zcyw3Mjh4MTM2NjtkYXRhX3JjLDE7ZGF0YV9mYixubzs6MzE1MTYyOTo6OjAuMDE&subid=g-50033060-4f1eb6ffc1ca4bca85cc4aec8dbfe1d4-&data_ss=728x1366&data_rc=1&data_fb=no&data_tagname=A&data_ct=link_only&data_clickel=link&data_sid=bda55c9d1a64a3efa156c5f5569f0865" target="a652c_1486592840_wwwinterfaceedupk_379598">CLOTHES and often chooses not to comb his hair. His speech has been incoherent. His symptoms seem to be worsening. All examination is normal except that BP =130/80 mmHg. A CT scan of the head, TSH levels, vitamin B12 and RPR are all normal. What would be the most appropriate treatment?



A 30-year-old woman has gradual onset of bilateral lower extremity weakness over the past 5-6 days. She has also had weakness in her right arm, as well as bowel and bladder incontinence. She had a cold 1 week ago. Temperature = 100.8◦F (38.2 ◦C). She is normotensive, with HR of 77beat/min. There is mild weakness of her right face, 4/5 strength in her right arm, and 2/5 strength in lower extremities. She has poor rectal tone. MRI of the spine and brain shows lesions throughout the white matter and spinal cord. Diagnose:



A 60-year-old homeless, homosexual man has had recurrent genital lesions and one episode of seizures. He is febrile, BP is 100/60 mm Hg, and pulse is 80/min. His is cachectic and only knows that he is in hospital. He has white plaques on different areas of his tongue. On neurologic examination, the patient is able to ambulate but has an ataxic gait. His strength is equally diminished in all four extremities. The rest of the examination is normal. A STAT head CT scan and a preliminary result of hypodense patchy lesions in the white matter are found. Which of the following is the best next step?



A 31-year-old woman has noticed gradual blurring of her vision over the past 5 days. 6 days ago, she noticed a vague pain especially when moving her right eye. Her vision worsened progressively but has stabilized within the past 30 hours. Her visual acuity is 20/80 (right eye) and 20/20 (left eye) per a Snellen´s chart. Her color perception is also diminished. There is decreased afferent pupillary response in the right eye as compared with the left. She is given a presumptive diagnosis of acute demyelinating optic neuritis. Which of the following is the common funduscopic finding in this disorder?



A 65-year-old woman has slowly progressive dementia. She was once found talking to an invisible person. Mental status examination reveals severe deficits in attention, visuo-spatial skills, and verbal fluency, while short-term memory is only mildly impaired. Physical examination reveals jerking movements of the arm with application of resistance. MRI of the head demonstrates mild diffuse cortical atrophy. Which of the following is the most likely diagnosis?



A 59-year-old woman has weakness lifting herself from a seated position or with brushing her hair and easy fatigability. For few months, she has dry mouth and dizziness on standing. She has a spotted rash across her chest. The only thing she has found to help her weakness is to "just keep at it. Repeated effort improves her symptoms, whereas rest does not benefit her. It is worse in the morning and improves throughout the day. She had chronic bronchitis due to 80-pack- year history of tobacco use, hypertension, and dyslipidemia. She has a worsening cough, mild pleuritic chest pain, and an unintentional 30-pound weight loss over the past 3 months. Physical examination reveals normal muscle tone and bulk but marked proximal muscle weakness. Which of the following is the most likely cause of this patient´s weakness?



A 32 year old woman who suffers from migraine complains that taking the recommended dose of paracetamol during an attack fails to relieve her headache. She has no other significant past medical history. She smokes 15 cigarettes per day and also drinks alcohol 16 units per week. Which factor most likely explains the lack of efficacy of paracetamol in her?



A 75 year old man has left-sided weakness. The weakness developed slowly over the preceding 6 hours. On exam he has a left hemiparesis and left facial weakness. His blood pressure is 180/100 mmHg and a heart rate 90 bpm regular. His wife tells you that he has been choking on fluids since the weakness developed. The first action out of the following would be



A 28 year old woman has drooping of the left side of her face and an inability to close her left eye. She had a viral illness in the preceding week. There is no past medical history. On exam, there is a left VIIth nerve palsy. Remaining cranial nerves are normal. Power, tone and reflexes are normal in the limbs. The best course of treatment is which one of the following?



Which statement is correct concerning pseudotumour cerebri (benign intracranial hypertension)?



A 37-year-old man has fever and confusion for 3 days. Hemodynamically he is fine. He is oriented to person only. There are petechiae and ecchymosis over the chest and both lower extremities. There is no neck stiffness, and no localizing neurologic sign.





























































Laboratory studies:
Hematocrit: 21 %
Hemoglobin: 7.2 gm/dL
WBC: 9,000/mm
Platelets: 13,000/mm
MCV: 89 um3
Reticulocyte count 5%
Creatinine 1.8 mg/dL
AST: 24 U/I
ALT: 25 U/I
Serum Lactate dehydrogenase 648 U/I
Serum total bilirubin 2.2 mg/dL
Prothrombin Lime 12 seconds
Partial thromboplastin Lime 30 seconds

Peripheral smear shows schistocytes and decreased platelets. Which of the following is the most likely diagnosis?



A 73-year-old man presents with an abrupt onset of double vision and left leg weakness. Examination shows weakness of abduction of the right eye and right-sided facial weakness affecting upper and lower parts of the face. He also has a left hemiparesis. Where is the lesion?



A 76 year old woman is admitted to the hospital following a fall at her home. On examination, she is dazed, has no memory of her fall and is unable to respond to any questions about her health. Left femoral neck fracture was seen on X-ray film. She is known to have taken butabarbital daily for many years. Uneventful surgical repair of the femur fracture is done the morning after admission. The patient becomes combative, begins to hallucinate and has a brief, generalized tonic-clonic seizure on the evening after the operation. Which is the cause of her behavioral change?



A 70 year old man presents with ptosis, myosis and anhydrosis on the left side. The most likely cause of this condition is which of the following?



A lady complains of early morning headache. She also has vomited a few times and has nystagmus. This has been going on for 6 months. The next step in your investigation would be



A 38 year old man is brought to the emergency department by his same sex partner because of confusion, diplopia and mild right arm weakness. On examination the patient is somewhat agitated and shows confusion for recent events. There is decreased papillary response on the left with some paresis of lateral gaze on the right. Temperature is 38.3°C (101.0°F). Peripheral leukocyte count is increased. What is the most appropriate next step in evaluation of his neurologic signs and symptoms?



A young man while running feels a sudden crack in his calf. The best clinical sign to diagnose Achilles tendon rupture is which one of the following?



Correct statement regarding Wernicke´s encephalopathy is



A man complains that recently he has a shooting type of pain in his face when he shaves. It happens once in a while and then goes away. You suspect trigeminal neuralgia. The treatment of choice is



What is the treatment of choice for absence seizures?



A 5 year old girl presents with acute vomiting and nuchal rigidity. MRI reveals a tumor in the posterior fossa consisting of a large cyst with a nodular mass attached to its wall (cyst with "mural nodule"). Histologic examination shows elongated astrocytes with long bipolar processes and numerous Rosenthal fibers. The most likely diagnosis is



A 60 year old male, who is known to have an arteriovenous malformation in his brain, develops what he reports as "the worst headache of my life." He is taken to the hospital by ambulance, but his condition deteriorates rapidly. The most likely associated with the patient´s condition is



A lady has complaints of muscle weakness. Physical exam shows the following rash which you recognize as goittrons papules. See picture:

The most likely diagnosis is



A 27 year old man presents with muscular rigidity and dyskinesias. His level of consciousness fluctuates, and he is highly febrile. Incontinence and mutism are noted. He is diagnosed with neuroleptic malignant syndrome. LEAST useful in the treatment of the patient´s symptoms is



The chance of genetic transmission of Huntington´s chorea from a man to his son is



A 55 year old has a recent traumatic shoulder injury. He develops severe burning hand pain associated with swelling and shiny skin. He is probably suffering from which one of the following?



An autopsy is being performed on a 65 year old man who died from a fall. Before his death his family had noted that he had been depressed and forgetful and had moved about slowly with constant tremors in his hands. Substantia nigra of the brain would show



A 60 year old man´s autopsy is being performed who developed progressive dementia, Parkinsonism, and visual hallucinations beginning 5 years before his death. Histopathology shows numerous eosinophilic intracytoplasmic inclusions within neurons of substantia nigra, limbic cortex, and basal nucleus of Meynert that are immunoreactive for ubiquitin. The most likely diagnosis is



An 85 year-old-woman had an anoxic brain injury1 week ago in which she was pulseless for 5 minutes. She is vitally stable with assisted continuous mechanical ventilation. Pupillary and corneal reflexes are present bilaterally. There is episodic decorticate rigidity, but no purposeful movement present. An EEG suggests severe, diffuse cortical damage. Her husband asks the physician if the patient is brain-dead. Which of the following is the most appropriate response?



A 40-year-old Asian male with history of hypertension presents to the emergency room with seizures. He was watching television and noticed a "funny feeling." He then had a tonic-clonic seizure. The patient was in a postictal state when he was brought to the emergency room. However, over the next 2 hours his mentation improved. He says that he has not had seizures in the past. He denies any fever, chills, vomiting, weakness, or incontinence. Physical examination shows a temperature of 36.8◦C (98.2 ◦F). Blood pressure is 120/70 mm Hg, respiratory rate is 18/min, and heart rate is 76/min. Pupils are equal, round, and reactive to light. Fundus examination shows no papilledema. There is no neck rigidity. There is no lymphadenopathy Lungs are clear to auscultation with no wheezes or crackles. Cardiovascular examination shows normal S1 and S2 with no rubs or gallops. Abdomen is soft, nontender, and nondistended. Bowel sounds are active. Extremities show no pitting edema. Neurologic examination is within normal limits. Lab results are:


























































Hgb: 13.6 g/dL
WBC: 8,000/mm3
Lymphocytes: 40%
Eosinophils: 13%
Platelets: 270,000/mm3
Sodium: 134mEq/L
Potassium: 4.6mEq/L
Chloride: 102mEq/L
Bicarbonate: 27mEq/L
BUN: 16 mg/dL
Creatinine: 0.9 mg/dL
Glucose: 80 mg/dL
Calcium: 9.2 mg/dL

Contrast CT scan shows multiple ring enhanced lesions at the gray-white junction. CSF examination shows normal protein and glucose levels. There are 0 to 1cells/mm3. The CSF cryptococcal antigen and toxoplasma PCR are negative. What is the most likely diagnosis?



A 36-year-old man develops rapid mental status deterioration two days after sustaining a femoral fracture. There are multiple petechiae in the anterior chest and abdomen. On the third day, he becomes comatose and dies. Postmortem examination of the brain reveals numerous petechial hemorrhages in the corpus callosum and centrum semiovale. Which of the following is the most likely diagnosis?



A 29-year-old woman has progressive weakness of her arms and neck such that her "head feels heavy" since a week. She has droopy eyelids and difficulty swallowing and chewing. Every respiration now is a challenge. She has had similar episodes over the last 3 years that worsen with repetitive activities and improves with rest. Weakness is worse in the ocular, facial, bulbar, and proximal limb muscles. Reflexes are intact and symmetric. She is monitored and requires intubation and transfer to ICU in next 12 hrs. Which of the following is the most appropriate immediate treatment for this patient´s underlying disease?



A 34-year-old woman has sudden paralysis of the lower limbs and dizziness since yesterday. She had fever, headache, and runny nose for last 5 days. She also has blurriness and discomfort in the left eye for last 2 hours. Now she is vitally stable and afebrile. There is total loss of power, reflexes, and sensation in her lower extremities, upper extremities are intact. She has full distended bladder. She is completely oriented and conscious. MRI show well-demarcated periventricular areas of T2 hyperintensity. Which of the following is the most likely diagnosis?



A 34-year-old- man has dizziness, right-sided tinnitus and fluctuating hearing loss on the right side. Dizziness occurs several times/week, lasting from 30 minutes up to several hours. He describes the tinnitus as an intermittent, roaring type sound. Now he seems good and has no other important history. He is vitally normal with normal examination. An audiogram reveals normal hearing bilaterally. What is the most likely diagnosis?



A 78-year-old has "waxing and waning" worsening mental status after he tripped and fell 2 weeks ago and hit his head on the icy pavement. Being vitally stable, he is alert only to person and tells you that he has had a headache ever since the fall. His strength is equally weak in all four extremities. No other findings exist. What do you expect to find on a CT scan of the head?



A 75-year-old man (otherwise well) has frequent falls; about three times in the last 4 weeks. His past medical history is significant for CAD, hypertension, hyperlipidemia, osteoarthritis, benign prostatic hyperplasia, and depression. His medications are isosorbide dinitrate, atenolol, lisinopril, simvastatin, ibuprofen, terazosin, and sertraline. His temperature is 36.7 °C (98.0 °F), pulse is 82/min sitting and 88/min standing, blood pressure is 128/68 mm Hg sitting and 122/64 mm Hg standing, respirations are 16/min, and oxygen saturation is 100% on room air. Auscultation of the lungs reveals decreased breath sounds at the bases. What would be the most appropriate next step?



A 71-year-old woman has watery nasal discharge in the absence of respiratory tract infection and mild headache for the last several days. Loratadine did not improve the suspected allergic rhinitis. Analysis of the nasal discharge confirms the presence of beta-2-transerrin. What is the most common complication that this patient may have?



A 70-year-old woman has personality changes and forgetfulness for the past 3 months after her husband´s death 6 months ago. She answers the physician´s questions with "Yes," "No" or "I don´t know," and appears apathetic and indifferent. When asked questions testing short-term memory, she often replies "I don´t know." T1-weighted MRI shows:

Which of the following is the most likely diagnosis?









A 32-year-old woman has altered mental status for the last few days. Although moderately febrile, she is stable. She shies away from the penlight and moans in pain as her neck is flexed. CT shows mild left temporal lobe edema. CSF shows















White blood cells 382cells/mm (80% lymphocytes)
Protein: 78 mg/dL
Glucose: 70 mg/dL

Gram stain does not reveal any organisms and cultures are sent. Ceftriaxone and vancomycin therapy is initiated. What should be added?



A 35-year-old male after getting his salary went to a bar and got drunk and fell asleep due to heavy drinking. He then presents to casualty with weakness of his left hand. Examination reveals weakness of left wrist and finger extension. What is the most likely diagnosis?



An 18 year old girl presents you having had five blackouts over the last year, all while she is standing up. She gets warnings of blurred vision, nausea, and feeling hot. She has been witnessed twice to have jerking of all limbs while she is unconscious. The attacks last for 30 to 60 seconds. Recovery is quick after the attack. She has never bitten her tongue or sustained any injuries. Physical examination and an ECG are normal. Her grandmother and sister suffer from epilepsy. Which of the following investigations is the most appropriate?



A patient develops left ptosis and diplopia a few hours ago, and later develops weakness of his left arm. The most appropriate investigation to order is



The sleep disorder that is in general class of circadian sleep disorders and may respond to bright light therapy is



A 71-year-old woman presented with a relatively short history of headaches and episodic impairment of consciousness. What is the most likely cause?



A nerve injury in which the nerve is stretched and bruised, producing a physiologic block to conduction but without axonal disruption, is known as



The most effective medication for restless legs syndrome is



A 50-year-old male demonstrates a poorly coordinated gait and cannot perform the finger-touch tests. Which one of the following represents the most likely cause?



An adult patient presents with persistent headaches. Head CT scan demonstrates a 2 cm spherical mass at the junction of the white and gray matter of the lateral aspect of the cerebral hemisphere. This lesion is most likely caused by which one of the following?



A 25 year old woman is brought to the emergency room with a number of symptoms that include extremely small pupils. All of the following can be included in the differential diagnosis of this condition, EXCEPT



A 9 year old boy shows rapidly deteriorating cognitive function. He is not oriented to time, person, or place. He exhibits nuchal rigidity and a high fever. According to boy´s mother, he has been swimming in a lake at a by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=199466&Page=13#67815020">CAMPGROUND in western Pennsylvania. The physician diagnoses the boy with meningoencephalitis. The most likely infectious agent involved in this boy is which one of the following?



During the physical exam of a patient´s foot, you notice an inability to dorsiflex. Pathology is associated with?



What is the appropriate treatment for exposure to organophosphates?



Which of the following is NOT true regarding the human spongiform encephalopathies?



A 64 year old man started to be more forgetful and to have slight personality changes. No somatic complaints or change in usual habits was observed. The patient´s father also had similar personality changes. The most likely diagnosis is



A patient who had been given metaclorpromide, a dopamine receptor antagonist, develops an acute dystonic reaction. Most useful in the treatment of the acute dystonia would be which one of the following?



Which one of the following is NOT a precipitating factor for migraine headache?



Which of the following treatment is NOT used in the management of myasthenia gravis?



A man with severe arthritis suddenly becomes unable to move his arms or legs. He is admitted to the neurology floor of the hospital, but his quadriplegia does not improve with time. The type of arthritis that causes the quadriplegia is



A 26-year-old man type 1 diabetic (controlled), an occasional drinker has decreased pain and temperature sensation of the upper extremities and across the shoulders and upper torso anteriorly and posteriorly for the last few months. He had a traumatic cervical spine injury. He also has constant aching pain involving neck and shoulders for the same duration. He has normal touch and vibration in the upper extremities, but there is weakness, spasticity, hyperreflexia, and impaired position and vibration sense in the lower limb. The rest of the sensory examination is normal. Loss of power and intrinsic muscle group atrophy are noted in both hands. Cranial nerve examination is normal. CT scan of the head is normal. What is the most likely diagnosis?



A 34-year-old is found to have an unknown mediastinal mass on CXR. She is surprised as she had felt better shortly. She has history of depression treated with low-dose sertraline; and myasthenia gravis, believed to be in remission since treatment with glucocorticoids 6 months ago. She has 8-pack-year tobacco history and family history includes an aunt with breast cancer at age 68 years. Physical examination, including a careful lymph node and breast examination, is unremarkable. Outpatient follow-up is arranged and the patient is sent home. Which of the following is the most likely diagnosis of this patient´s mediastinal mass?



A 30-year-old man has severe progressive localized lower back pain for 3 weeks. He recently has had intermittent episodes of night sweats, fevers, and chills. He has problems of bowel control. No relevant past history exists. Temperature =39.9°C (102.0 °F), BP=100/60 mm Hg and pulse=120/min. There are multiple needle marks all over his arms and legs, with some small surrounding areas of petechiae. A 3/6 systolic ejection murmur radiating to the carotids exists. There is point tenderness over the lumbar region of which he complains. TLC=32,000cells/mm3 and ESR =100 mm/h. What is the most likely organism?



A 60-year-old male has low back pain that usually starts while walking. Ibuprofen did not benefit. He has a history of hyperlipidemia, diabetes mellitus, and hypertension. Currently, his takes lisinopril, simvastatin, and metformin. A diagnosis of spinal stenosis is suspected. Which of the following findings would support this diagnosis?



A 65-year-old man has increasing weakness and fatigue for 6 months. He denies weight loss. Being vitally stable, he speaks with a soft and monotonous tone of voice. He walks with a rigid posture and limited arm swing. A fine tremor of the fingers exists that manifests at rest and disappears with movement Increased muscle tone is appreciated when his arms are passively flexed. Sensation and muscle strength are otherwise intact. Which of the following drugs is most likely to produce a marked improvement in this patient´s symptoms?



A 15-year-old male has been having epistaxis for the past 4 months from left nostril; although not severe. There is no history of trauma. He complains of rhinorrhea with occasional blood-tinged nasal discharge from the same nostril. He had had a chronic left serous otitis media and diminished hearing. A firm grayish-red mass in the left posterior nasal pharynx exists. Which of the following is the most likely diagnosis?



A 69-year-old man for the last 2 months has had intermittent shocklike and stabbing pain over his right jaw and mandible. The pain is severe and brief, lasting only seconds. Brushing and even chewing tough food can trigger it. Which of the following medical therapies is most likely to benefit this patient?



Least likely to cause choreiform movements is which one of the following?



A 66 year old man presents with bilateral leg pain. Past medical history is not significant, and no excess alcohol use. Both knee reflexes are reduced. Fasting glucose is 6.5mmol/L. The next most likely investigation to confirm the diagnosis is which one of the following?



An 11 year old boy is brought to your office after accidentally cutting his left hand with a pocketknife. You find a deep 2-cm laceration at the base of the thenar eminence on examination. To test for motor injury to the median nerve you would have the patient



The most important factor for preventing a cerebrovascular accident (CVA) is



A 58 year old man is brought to the emergency department by the rescue squad after he was found lying unconscious in the street. No other history is available. On physical examination he has a temperature of 40.0C (104.0F) and marked nuchal rigidity. While awaiting the results of a lumbar puncture, which of the following is the most appropriate intravenous pharmacotherapy?



A 24 year old male present with severe headache, neck pain, photophobia and fever. Results of several investigations are negative and you decide to do a lumbar puncture, which shows viral meningitis. Which of the following would not be shown on CSF analysis?



A 42 year old man complains to his doctor of impotence. The appropriate medication to be implicated is



Which of the following symptom cannot be explained by local expansion of acoustic neuroma?












A 77 year old lady has a follow up radiologic study after having been involved in a motor vehicle accident several months ago. During the initial incident, she was found to have suffered a large intracranial hemorrhage. Her current scan (see image) reveals a large hygroma that has replaced the original site of hemorrhage. The original hemorrhage site best represents which of the following?



A leukemic patient who has undergone under multiple courses of chemotherapy develops fever. He later becomes mentally obtunded and develops lower extremity weakness. A presumptive diagnosis of herpes simplex encephalitis is made on the basis of clinical exam and lumbar puncture. What would a brain CT show?



A 49 year old female who works as a paralegal in a law firm comes to her local doctor because of problems with sleep. The patient says that over the past several weeks, she hasn´t slept well, fells tired, and has had headaches. She does not smoke or drink alcohol except on special occasions, and clues not take any medications. The patient´s pupils are 5 mm in size, equal and reactive, with both the direct and consensual light reflexes intact. Accommodation is unimpaired. Examination of the visual fields and funduscopy are unremarkable. Extraocular movement´s reveals normal conjugate, oblique and downward movement, but she is unable to look upwards. Rest of the neurological examination is also normal. The most likely diagnosis is



A person is brought to the emergency room by the police after they observe him staggering down the street in a disoriented state. He appears malnourished and smells like wine. The edge of the liver is difficult to palpate, but feels nodular to the examiner. Multiple bruises are also noted on examination, and a new bruise is produced by the blood pressure cuff. Ocular examination reveals horizontal nystagmus on lateral gaze, and bilateral lateral rectus palsies. The neurological problems observed in this patient are caused by deficiency of which vitamin?



All of the following are likely to be associated with peripheral neuropathy, EXCEPT



Radicular pain is NOT exacerbated by which one of the following maneuvers?



A 35 year old HIV positive woman presents with headache. During examination, she becomes more confused and begins to feel nauseous. Nuchal rigidity was present and cryptococcal meningitis is suspected. A spinal tap is performed. The most useful diagnostic test is



Which of the following has NOT been postulated to explain the behavioral and cognitive abnormalities in Alzheimer´s disease?



Which one of the following is the most common cause of death from delirium tremens?



A man is brought because of multiple episodes of "fainting." CVS exam is negative, but a medical condition is suspected. EEG shows an abnormal spiking pattern. Which type of seizure did he likely experience?



A 79-year-old woman has sudden onset of lower extremity weakness and collapse on getting out of bed. Her upper extremity sensation and strength are intact and her legs are weak bilaterally, with loss of pain and temperature sensation and areflexia. Her bladder is distended. Which of the following is the most likely diagnosis?



An 11-year-old boy complains that his head hurts all over but is worse over the front and back. The headaches started approximately 1 month ago and were controlled with ibuprofen at first, but are now worsening. They tend to start in the morning after he gets out of bed and last through the afternoon. Today it ended about 2 hours ago. On physical examination, his only positive finding is slight ataxia. Which of the following is the next step in management?



A previously healthy 37-year-old woman has recurrent episodes of double vision and drooping of her eyelids for the last month. They occur without apparent reason, last for hours, and resolve spontaneously. She also has occasional hoarseness and difficulty swallowing, which also come and go. Vital signs and physical examination are normal. Which of the following tests will confirm the diagnosis?



A 42-year-old complains of involuntary movements for the last several months. Few months ago, he also had face grimacing and awkward "dancing" movements of his upper extremities. He has been irritable, forgetful and depressed and has difficulty naming objects. He has past medical history of hypertension and seizures and takes lisinopril and phenytoin. His father had involuntary movements and died at the age of 48. Mental status examination shows impaired cognitive ability. Sensory examination is normal. LP, CBC, chemistry profile, and LFTs are normal. What is the most likely diagnosis?



A 58-year-old diabetic has suffered a "burning" pain in her legs and occasional sharp, lancinating pains that shoot up her legs for the last 2 years. It is intermittent and mildly relieved with over-the-counter pain medications. She had mild relief with combination of hydrocodone and acetaminophen. It is unrelated to exertion and does not go with rest. Except for this pain she has no other symptoms. She has retinopathy and diabetic gastroparesis, and an MI 4 years ago. Which of the following medications is most likely to benefit?



A male infant (breast fed and unproblematic) has now not been feeding well. The mother is going back to work and would like to switch to formula feeding. The pediatrician tells her that this is fine. 3 weeks later, he is still not feeding well despite the change to the bottle. At this visit the pediatrician finds generalized hypotonic, absent deep tendon reflexes, and fasciculations of the tongue. Which of the following findings is characteristic of this disorder?



A 40-year-old has a 1-year history of personality changes, abnormal involuntary movements, and memory dysfunction. His father and grandfather died in their 50s because of progressive mental deterioration accompanied by movement abnormalities. He has no children. He has difficulty in concentration, mild depression, and marked restlessness. There is grimacing of the face and intermittent shrugging of the shoulders. MRI brain shows hyperintensity in the region of the caudate on T2-weighted images. Which of the following is the most likely diagnosis?



A 70-year-old woman has pain with burning and tingling sensation localized to the right side of her back for 6 months without any improvement. She describes having had a vesicular rash over that region of her back when the pain first began, but the rash has long since resolved. It never crossed the midline of her back and was distributed in well demarcated strip from her spine to her shoulder. It was associated with low-grade fevers and myalgias, now also resolved. No rash exists now. Which of the following is the most appropriate treatment for her condition?



A 50-year-old man has worsening blurred vision, difficult speaking, and difficulty swallowing. His two office friends have had similar symptoms. He also has nausea, constipation, and dry eyes. He has bilateral ptosis. Muscle power is reduced in the shoulder and arm, but normal in the lower extremities. The sensory exam is unremarkable. What is the most likely diagnosis?



A woman aged 20 years presents with a sudden onset of left sided head and neck pain. 24 hours later she presents with sudden onset of right hemiparesis, facial weakness and homonymous hemianopia and left horner´s syndrome. CT of brain shows a left middle cerebral artery territory infarction. The likely diagnosis is



A 69 year old woman has weight loss, headaches for 4 months and recently developed double vision. 6 years ago she underwent a right mastectomy for breast carcinoma and is on treatment with Tamoxifen. Exam revealed tenderness over the temporal region and left sixth nerve palsy. She has an ESR of 100 mm/hr (0-30) and her Hb was 10.8 g/dL (11.5-16.5). The correct statement is



A 36 year old male patient is given a battery of neuropsychological tests. He scores 85 on the Wechsler adult intelligence scale (WAIS) Verbal 10, 135 on the performance 10 tests, and 125 on the Wechsler memory scale tests. The most likely site of his brain dysfunction is



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