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🧠 Clinical Case Challenge
🏢 Brand: AMBOSS
📚 Source: AMBOSS Neurology

📝 .nowrap { white-space: nowrap; } .scientific-name { font-style: italic; } .wichtig { font-weight: bold; } A 67-year-old man comes to the physician because of a worsening tremor that began 1 year ago. The tremor affects his left hand and improves when he uses his hand to complete a task. He also reports feeling stiffer throughout the day, and he has fallen twice in the past year. He has not noticed any changes in his cognition or mood. He has not had difficulty sleeping, but his wife says that he would kick and punch while dreaming for almost a decade. His mother has Alzheimer disease. He drinks two cans of beer daily. He takes no medications. He appears well-nourished. Vital signs are within normal limits. The patient maintains a blank stare throughout the visit. Further evaluation is most likely to show which of the following? Show HintThis patient's asymmetrical resting tremor, rigidity, and reduced facial expression (hypomimia) should raise concern for idiopathic Parkinson disease (PD), which is commonly associated with sleep disturbances (e.g., REM sleep behavior disorder) during early stages of the disease.

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🧠 Clinical Case Challenge
🏢 Brand: AMBOSS
📚 Source: AMBOSS Neurology

📝 .nowrap { white-space: nowrap; } .scientific-name { font-style: italic; } .wichtig { font-weight: bold; } A 5-day-old male newborn is brought to the emergency department 1 hour after having a seizure. It lasted approximately 1 minute, and involved blinking and lip-smacking movements as well as left-sided jerking of the hand and foot. His mother says she measured a temperature of 38.2°C (100.7°F) at that time. He has had increasing difficulty feeding since yesterday. He was born at 39 weeks' gestation and weighed 3189 g (7 lb 1 oz); he currently weighs 2980 g (6 lb 9 oz). The mother's prenatal course was significant for gonorrhea infection diagnosed early in pregnancy and treated with ceftriaxone and azithromycin combination therapy. The boy appears irritable and lethargic. His temperature is 36.0°C (96.8°F). Examination shows clusters of vesicular lesions with an erythematous base on the patient's face and trunk. There is profuse lacrimation. Laboratory studies show: Leukocyte count 16,200/mm3 Segmented neutrophils 25% Bands 5% Lymphocytes 65% Monocytes 3% Eosinophils 2% Serum Glucose 80 mg/dL A lumbar puncture is performed. Cerebrospinal fluid analysis shows a leukocyte count of 117/μL, a protein concentration of 52 mg/dL, and a glucose concentration of 58 mg/dL. Results of blood cultures are pending. Which of the following is the most appropriate pharmacotherapy? Show HintA seizure accompanied by fever is strongly concerning for neonatal meningitis and/or encephalitis. A high CSF protein and normal CSF glucose (∼ ⅔ of blood glucose) suggest a viral CNS infection. His diffuse vesicular rash suggests neonatal herpes simplex virus (HSV) infection.

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🧠 Clinical Case Challenge 🏢 Brand: AMBOSS 📚 Source: AMBOSS Neurology 📝 .nowrap { white-space: nowrap; } .scientific-name { font-style: italic; } .wichtig { font-weight: bold; } A 5-day-old male newborn is brought to the emergency department 1 hour after having…

🧠 Clinical Case Challenge
🏢 Brand: UWorld
📚 Source: Internal Medicine QBank (ABIM) 2026

📝 A 19-year-old man from Arizona is brought to the emergency department by his parents due to a high-grade fever, chills, and headache. He also complains of severe pain in the groin and axillary areas, which was preceded by swelling. Two days prior to this event, the patient's father was changing carpet in the patient's room and noticed a dead rat. His temperature is 39.6 C (103.3 F), blood pressure is 100/70 mm Hg, and pulse is 98/min. Examination shows multiple severely tender, non-fluctuant, enlarged nodules in the axillary and groin regions. The skin over these areas is edematous and erythematous. Blood cultures are obtained. Which of the following organisms is most likely responsible for this patient’s infection?

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🧠 Clinical Case Challenge 🏢 Brand: UWorld 📚 Source: Internal Medicine QBank (ABIM) 2026 📝 A 19-year-old man from Arizona is brought to the emergency department by his parents due to a high-grade fever, chills, and headache. He also complains of severe pain…

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🧠 Clinical Case Challenge 🏢 Brand: AMBOSS 📚 Source: AMBOSS Neurology 📝 .nowrap { white-space: nowrap; } .scientific-name { font-style: italic; } .wichtig { font-weight: bold; } An 8-year-old boy is brought to the physician by his parents for short stature.…

🧠 Clinical Case Challenge
🏢 Brand: AMBOSS
📚 Source: AMBOSS Neurology

📝 .nowrap { white-space: nowrap; } .scientific-name { font-style: italic; } .wichtig { font-weight: bold; } A 31-year-old man comes to the emergency department because of facial drooping on the left side since awakening that morning. He had difficulty chewing his food at breakfast. He was treated the previous day at the hospital after sustaining a head injury from falling off of a ladder. A CT scan of the head showed no abnormalities. He is in no apparent distress. His vital signs are within normal limits. The pupils are equal and reactive to light. There is drooping on the left corner of the mouth. The left nasolabial fold is flattened. When he is asked to close both eyes, his left eye remains partially open. When he is asked to raise his eyebrows, there are no wrinkles on the left side of his forehead. Which of the following is the most appropriate next step in management? Show HintFacial muscle paralysis (lagophthalmos of the left eye, drooping of the left corner of the mouth) that does not spare the ipsilateral forehead is consistent with peripheral facial nerve palsy.

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🧠 Clinical Case Challenge 🏢 Brand: AMBOSS 📚 Source: AMBOSS Neurology 📝 .nowrap { white-space: nowrap; } .scientific-name { font-style: italic; } .wichtig { font-weight: bold; } A 31-year-old man comes to the emergency department because of facial drooping…

🧠 Clinical Case Challenge
🏢 Brand: AMBOSS
📚 Source: AMBOSS Neurology

📝 .nowrap { white-space: nowrap; } .scientific-name { font-style: italic; } .wichtig { font-weight: bold; } An 8-year-old boy is brought to the physician by his parents for short stature. Neither his clothing nor his shoe size has changed over the past year. He also frequently bumps into obstacles such as furniture and has headaches at night. He is always thirsty for cold water and has been urinating more frequently. Three years ago, he had an asthma attack that was treated with albuterol and a one-week course of steroids. His mother has Hashimoto's thyroiditis and had precocious puberty. His mother's height is 147 cm (4 ft 10 in) and his father's height is 160 cm (5 ft 3 in). He is at the 5th percentile for height and 5th percentile for weight. His temperature is 37°C (98.6°F), pulse is 98/min, respirations are 16/min, and blood pressure is 100/64 mm Hg. Examination shows a soft and nontender abdomen. The genitals and pubic hair are both Tanner stage 1. Axillary hair is absent. Patellar reflexes are 1+ bilaterally. Laboratory studies show: Na+ 145 mEq/L K+ 4.1 mEq/L Cl- 102 mEq/L HCO3- 25 mEq/L Ca2+ 9.4 mg/dL Glucose 98 mg/dL Thyroid-stimulating hormone 0.2 μU/mL Thyroxine 3.9 μg/dL Insulin-like growth factor 1 24 ng/mL (N= 61–356) Insulin-like growth factor-binding protein 3 2.1 μg/mL (N = 1.6–6.5) Which of the following is the most likely diagnosis? Show HintThis boy has symptoms and laboratory findings suggestive of multiple hormonal deficiencies (diabetes insipidus, secondary hypothyroidism, and growth hormone deficiency). The fact that the child frequently bumps into obstacles suggests that the child has a peripheral visual field defect.

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🧠 Clinical Case Challenge 🏢 Brand: UWorld 📚 Source: Internal Medicine QBank (ABIM) 2026 📝 A 24-year-old woman is being evaluated for positive reactive plasma reagin (RPR) testing for syphilis as part of a routine prenatal workup. The current titer is 1:8.…

🧠 Clinical Case Challenge
🏢 Brand: UWorld
📚 Source: Internal Medicine QBank (ABIM) 2026

📝 A 24-year-old woman is being evaluated for positive reactive plasma reagin (RPR) testing for syphilis as part of a routine prenatal workup. The current titer is 1:8. She feels well and has no complaints. Six months ago, she went to the hospital with fever and a diffuse rash following sexual activity with a new male partner. There she underwent testing that showed an RPR titer of 1:256. The Treponema pallidum particle agglutination assay was positive at that time. HIV testing was negative. The patient was treated for secondary syphilis with intramuscular penicillin G. Her symptoms resolved over the next week. Her partner also was treated appropriately for syphilis at that time; she has had no new sexual partners. Complete examination, including genital and neurologic examination, is normal. Repeat HIV antibody testing is negative. What is the best next step in management of this patient?

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