Movement Disorders USMLE Step 1 Practice Question
A 34-year-old woman presents with a 2-day history of acute-onset involuntary jerking movements of the right arm and leg, along with facial droop, dysarthria, and dysphagia. She reports having pharyngitis 1 week prior, treated symptomatically. Vital signs are stable (BP 118/76 mmHg, HR 92 bpm, RR 16/min, Temp 37.2°C). Laboratory findings reveal ESR 62 mm/hr and elevated antistreptolysin O titer. Brain MRI shows no acute infarction or mass effect. Lumbar puncture demonstrates mild lymphocytic pleocytosis (18 cells/μL) with normal glucose and protein. Which of the following is the most likely diagnosis?
Answer choices
- AAcute disseminated encephalomyelitis (ADEM)
- BAcute ischemic stroke
- CBacterial meningitis
- DSydenham choreaCorrect answer
- EAnti-NMDA receptor encephalitis
- FHypertensive emergency with posterior reversible encephalopathy syndrome (PRES)
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