A 38-year-old woman comes to the physician because of a 3-week history of involuntary movements of her extremities. One year ago, she was fired from her position as an elementary school teacher because she had stopped preparing lessons and was frequently absent without notice. She now lives with her mother. She appears emaciated and malodorous. Examination shows rapid, nonrepetitive jerks of her limbs and face that frequently end with the patient covering her face and yawning. She has an unsteady gait. Genetic testing shows a mutation on chromosome 4. This patient's condition is most likely associated with increased levels of which of the following substances?
AGamma-aminobutyric acid
BN-acetyl aspartate
CGlutamate
DDopamine
EAcetylcholine
A 74-year-old man is brought to the physician by his wife for progressively worsening confusion and forgetfulness. Vital signs are within normal limits. Physical examination shows a flat affect and impaired short-term memory. An MRI of the brain is shown. Further evaluation of this patient is most likely to show which of the following findings?
APostural instability
BPill-rolling tremor
CChoreiform movements
DBroad-based gait
EPapilledema
A 73-year-old man presents to your office accompanied by his wife. He has been experiencing a tremor in his right hand for the last several months that seems to be worsening. He does not have any other complaints and says he’s “fine.” His wife thinks that he has also had more difficulty walking. His history is significant for hypertension and an ischemic stroke of the right middle cerebral artery 2 years ago. His medications include hydrochlorothiazide and daily aspirin. On physical exam you note that the patient speaks with a soft voice and has decreased facial expressions. He has a resting tremor that is worse on the right side. He has increased resistance to passive movement when you flex and extend his relaxed wrist. He has 5/5 strength bilaterally. Neuronal degeneration in which of the following locations is most likely responsible for the progression of this disease?
AVermis
BSubstantia nigra pars compacta
CFrontotemporal lobe
DCaudate and putamen
ESubthalamic nucleus
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