A 27-year-old man comes to the physician for a follow-up appointment. He has traveled extensively the past few years through Europe and Africa backpacking. A scraping from a skin lesion is shown. In the absence of appropriate treatment, which of the following is most likely to develop in this patient?

A) Asterixis
B) Intention tremor
C) Romberg sign
D) Pill-rolling tremor
E) Uhthoff sign

A 69-year-old man is brought to the clinic by his wife due to progressive difficulty walking and frequent falls over the past year. She reports that he often falls backward without warning and has developed increasing stiffness and slowness of movement. Physical examination demonstrates axial rigidity and Parkinsonism. Which of the following is the most likely diagnosis?

A) Amyotrophic lateral sclerosis
B) Lewy body dementia
C) Neuromyelitis optica
D) Progressive supranuclear palsy
E) Wilson disease

A 59-year-old woman comes to the physician for a 6-month history of progressively worsening hearing in her left ear. Physical examination shows cerumen impaction in the left ear. Which of the following is most likely to be seen in this patient?

A) Rinne test shows air conduction > bone conduction; Weber test louder in left ear
B) Rinne test shows air conduction > bone conduction; Weber test louder in right ear
C) Rinne test shows bone conduction > air conduction; Weber test louder in left ear
D) Rinne test shows bone conduction > air conduction; Weber test louder in right ear

A 26-year-old girl is evaluated in hospital 6 months after surgical resection of a brain tumor. MRI suggests there might be some moderate residual compression of the pituitary stalk. Which of the following hormones is most likely to be increased in this patient?

A) ACTH
B) FSH
C) Growth hormone
D) LH
E) Prolactin
F) TSH

A 56-year-old woman is brought to the physician by her husband for a 4-month history of progressive cognitive decline. He reports that she’s also had occasional involuntary muscle jerks, usually of the left arm. She has no past medical history apart from a right corneal transplant performed about 2 years ago. Which of the following is most likely to be seen in this patient?

A) Antibodies against aquaporin-4
B) CSF protein 14-3-3
C) Increased alpha-helices
D) Increased PrP^c
E) Parkinsonism

A 28-year-old woman is brought to hospital for a 1-week history of abnormal movements and sensation. She also reports decreased visual acuity in her right eye. Neurologic examination shows reduced motor function of the left leg, loss of pain and temperature in the right leg, and reduced vibration and proprioception of the left leg. Ophthalmologic examination shows visual acuity of 20/200 in the right eye; the left eye is normal. CSF analysis shows IgG oligoclonal bands. Which of the following is the most likely explanation for this patient’s findings?

A) Antibodies against aquaporin-4
B) Recent trauma
C) T cell attack against myelin basic protein
D) T cell attack against Schwann cells
E) Viral infection

A 61-year-old woman comes to the physician for a 4-month history of progressively worsening double vision and fatigue. Physical and neurologic examination show a partial ptosis of the right eyelid and a right pupil that is fixed at 1mm.

Which of the following is the most likely explanation for this patient’s findings?

A) Impingement of lower brachial plexus
B) Impingement of upper brachial plexus
C) Impingement of the C8 sympathetic chain
D) Loss of parasympathetic outflow
E) Reduction in oculomotor efferent outflow

A 66-year-old man is evaluated in hospital. A non-contrast CT of the head is shown.

Which of the following is most likely to be seen in this patient?

A) Alcoholism
B) Blood pressure of 180/100
C) Cystic kidneys
D) Limited crossing of suture lines
E) Lucid interval

A 45-year-old woman is evaluated in hospital. She has a history of HIV managed with HAART therapy and TMP/SMX. Her CD4 count is 87/μL.

Which of the following is the most likely explanation for this patient’s presentation?

A) Acute CNS infection
B) Hyperproliferation of B cells
C) Liquefaction
D) Reactivation of latent infection
E) T cell-mediated immune response

A 6-year-old boy is brought to the pediatric neurologist for a follow-up appointment. He has a several-month history of difficulty with upward gaze. A sagittal MRI is shown. A disruption of which of the following is most likely to be seen in this patient?

A) Circadian rhythm
B) Finger-to-nose test
C) Globus pallidus internus stimulation
D) Recognizing familiar faces
E) Romberg test