Diagnosis
A 32 yo F presents with a CC of R leg numbness and tingling. She states that the symptoms occurred suddenly and have continued for the past 2 days. She says that in the past, she had an episode where it felt like seh was also dragging her L leg and her speech was slurred. An MRI is obtained, showing periventricular abnormal FLAIR signal. Which of the following locations would be least likely to have additional lesions?
A. Corpus callosum
B. Pons
C. Middle cerebellar peduncle
D. Cervical cord
E. Lumbar cord
A 46 yo F presents to hospital because of bilateral lower leg numbness, weakness, and urinary retention for the last week. An MRI of the thoracic spine shows enhancement at T5-T6. CSF studies are unremarkable except for mildly elevated protein. What is the diagnosis?
A. Transverse myelitis
B. Neuromyelitis optica
C. Epidural abscess
D. Spinal meningioma
E. Spinal cord infarct
Sphinosine 1-phosphate receptor modulator; Binds to sphingosine 1-phosphate receptors blocking the lymphocytes ability to emerge from lymph nodes
What is Fingolimod's MoA
Ocrelizumab's main adverse side effect
What is upper respiratory tract infection
A 35 yo F presents with blurry vision and loss of abiliy to distinguish colors. Visual acuity is 20/200 in the L and 20/80 in the R. There is a relative afferent pupillary defect in the L eye. Strength is full throughout, and reflexes are 2+ and symmetric, with downgoing plantar reflexes. The results of a MRI B are normal. MRI of the orbits reveal bilateral optic nerve enhancement extending posteriorly near the optic chiasm. Which of the following is most likely to reveal the underlying diagnosis?
A. MRI C spine
B. CSF oligoclonal bands
C. MRI venogram of the head
D. Serum aquaporin-4 antibody
E. Dilated fundoscopic exam
An 18 yo F with no pMH presents with L arm weakness and R leg patchy numbness for 2 weeks. Neurologic examination shows L arm clumsiness and R leg sensory changes. MRI of the brain wwo contrast showing FLARI T2 hyperintensities perientricularly and in the subcorical white matter which are non-enhancing. MRI C spine wwo contrast showing L C2-C3 hyperintensity chanes that are enhancing. On further history, she does admit to an episode of R eye blurry vision associated with pain with eye movement aht occurred over a year ago, which resolved. What would be the preferred next step in management?
A. Dimethyl fumarate
B. IV Ig
C. Glatiramer acetate
D. Methylprednisolone
E. Rituximab
Humanized monoclonal antibody to CD20 B-cells; Directed against B-cells which express the cell surface antigen CD20
What is ocrelizumab's MoA
Fingolimod's main adverse side effect
What is AV block
A 28 yo F is admitted to the hospital with bilateral painful and blurry vision that developed over 3 days. One week later, she has developed paresthesias in her feet and urinary urgency. The results of an MRI of the brain are shown in the exhibit. Which of the following is incorrect about this disease?
A. This disease can affect the area postrema
B. This disease is caused by the formation of AQP-4 antibodies
C. IVIG can be used for acute treatment of the disease
D. Interferon beta can be used for disease modification
E. Eculizumab can be used for relapse prevention
An 8 yo child is seen int he ED for evaluation of confusion and weakness that started 36 hours ago, following an onset of fever. He is lethargic and only oriented to self. He has no prior medical problems. Examination shows CN VI palsy, dysarthria, and R sided hemiparesis. He is started on broad-spectrum antibiotics. Serology and CSF analysis are unremarkable for infectious etiology. MRI B shows multiple enhancing subcortical and brainstem lesions. Which of the following is true?
A. Acute treatment of choice is IV methylprednisolone
B. Prognosis is poor with hihg mortality rate
C. Diagnosis requires presence of oligoclonal bands in the CSF
D. Plasma exchange is more effective than IVIg
E. Most patients will develop MS in the future
Blocks myelind-damaging T-cells;
Induces and activates T-lymphocyte suppressor cells specific for myelin antigen
What is glatiramer acetate's MoA
Glatiramer acetate's main adverse side effect
What is injection site pain
A 45 yo M with HIV/AIDS comes to the hospital complaining of language problems. During the past 4 weeks, he has had progressive word-finding difficulties. Initially, he also noticed L leg weakness. In the past 2 weeks, he has also been developing R arm and leg weakness. On exam, he has expressive aphasia, R arm, R leg, and L leg weakness, and R visual field cut. Which of the following is true about the most likely diagnosis?
A. The presence of positive antibodies for the virus is diagnostic
B. Immunosuppressant treatment is indicated
C. This disease is caused by a picornavirus
D. This disease affects the oligodendrocytes
E. This disease has been linked ot the use of glatiramer acetate
A 33 yo F with MS presents to the ED complaining of vertigo. On your exam, she has a positive HINTS exam. Which is rue regarding the HINTS exam?
A. Positive head impulse is always concerning for a central process
B. Bidirectional nystagmus is indicative of a central process
C. Skew is horizontal misalignment
D. Bidirectional catch-up saccades are indicative of a peripheral process
E. the head impulse, nystagmus, test of skew (HINTS) exam can be done on a semiconscious patient
Humanized monoclonal antibody to alpha-4 integrin; Blocks integrin-adhesion molecule interactions and inhibits migration of T-lymphocyte migration into the central venous system
What is Natalizumab's MoA
Teriflunomide's main adverse side effect
What is teratogenicity
A 19 year old F with no pMH presents to ED following 2 days of worsening confusion, fever, and headaches. She reports that, about 1 week ago, she had waht she thought was food poisoning which improved with OTC meds. While being examined, she is noted to have tonic stiffening followed by R gaze deviation and generalized shaking. After this, she appears confused and somnolent and eventually becomes comatose. CTB without hemorrhage. MRI B pending. cvEEG showing moderate generalized slowing and no discharges or seizures. CSF shows mild elevation in protein level but otherwise unremarkable. What is the most likely diagnosis?
A. MS
B. Progressive multifocal leukoencephalopathy
C. Herpes simplex virus encephalitis
D. Neurosarcoidosis
E. Acute disseminated encephalomyelitis
A 34 yo F with MS presents to clinic complaining of a 2 week hx of nonstop clicking sound in her L ear. Her husband states he is even able to hear the sound, too, and sometimes wakes him up from sleep. Where would the causative lesion most likely be located?
A. Superior olivary nucleus
B. Dentate nucleus
C. Globiform nucleus
E. Embolliform nucleus
F. Festigial nucleus
A 32 yo F with RRMS presents to the office for follow-up. She states that for the past 3 months, she has been experiencing some difficulty with chewing and swallowing. She states that she also has been experiencing frequent involuntary crying that occurs in moments that she does not feel sad. The patient would like to start a medication for her involuntary crying. Which of the following indicates a mechanism of action for the only approved medication for this condition?
A. N-methyl-D-aspartate glutamate receptor antagonist
B. Selective serotonin reuptake inhibitor
C. Gamma-amminobutyric acid reuptake inhibitor
D. Monoamine oxidase inhibitor
E. Histamine H2 receptor antagonist
Dimethyl fumarate's main adverse side effect
What is flushing