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A 67-year-old male with a past medical history of hypertension and diabetes presents with a 5-day history of facial paralysis and an ear rash. The patient states he returned from a 4-day backpacking trip in the Adirondacks 2 weeks ago in upstate New York where he engaged in hiking and freshwater swimming. His temperature is 36.9 °C (98.5°F), pulse is 72/min, and blood pressure is 131/78. Examination reveals an erythematous vesicular rash in the left auditory canal and pinna and drooping of the left face, forehead, and eyelid. A Weber test lateralizes to the right ear and a Rinne test shows air conduction greater than bone conduction in both ears. What is the most likely diagnosis?
A patient presents with double vision that improves when tilting their head to the right. A lesion is most likely to be present in which of the following cranial nerves?
Which of the following is the thalamic relay center for proprioception of the face?
A 27-year-old woman presents with recurrent episodes of tinnitus, vertigo, and hearing loss. She denies any associated headaches. Episodes typically last between 2 and 6 hours in duration. MRI of the brain with and without contrast did not reveal any pathology. Physical examination is unremarkable except for sensorineural hearing loss appreciated in the right ear. Which of the following is the most likely diagnosis?
The trochlear nucleus sends nerve fibers to which of the following muscles?
Which of the following is the thalamic relay center for auditory stimuli?
A 24-year-old weight-lifter presents after sudden-onset neck pain. On exam, there is right eye ptosis and asymmetric right pupil constriction. Additionally, the patient appreciated decreased sweat production on the right side of his face. 1% hydroxyamphetamine eye drops are administered to the right eye and it dilates. Where is the most likely site of the patient’s lesion?
Which of the following is the relay center for hearing?
Which of the following cranial nerve(s) transverses through the structure (blue arrow) shown below?
The ophthalmic branch of the trigeminal nerve exits the skull from which cranial foramina?
Bilateral exotropia is typically seen with which of the following lesions?
Oculomotor nerve palsy is most likely to be seen secondary to an aneurysm in which of the following arteries?
Which of the following correctly identifies the cranial nerve(s) that transverse through the structure (blue arrow) shown below?
A 65-year-old female presents to the clinic with painless double vision that started abruptly 5 days ago. On exam, pupils are equal, round, and reactive to light bilaterally. On extraocular muscle testing, the left eye has a normal range of motion but the right eye is unable to adduct or elevate. Which of the following is the most likely cause of the patient’s symptoms?
Which answer correctly identifies all of the cranial nerve(s) that transverse through the structure (blue arrow) shown below?
A 35-year-old male presented for sudden onset painless central vision loss. An outside hospital emergency room physician suggested he may have had a CRAO, but recommended immediate ophthalmology outpatient evaluation. The patient was unfortunately lost to follow-up for a few months. He presents today due to a sudden onset of central vision loss in the other eye.
On your ophthalmologic exam, you note hyperemic optic nerve and tortuous central retinal vessels, without evidence of vessel cutoff. He has a central scotoma bilaterally, with peripheral vision intact. He has red color desaturation as well. MRI brain w/ and w/o contrast with fat suppression and thin cuts through the orbits is performed, and normal.
This disorder is caused by which of the following pathologic processes?
Which of the following are actions of the superior rectus muscle?
Of the following, which extraocular muscle is not innervated by the oculomotor nerve?
A 72 y.o. female presents to the clinic with complaints of decreased interest in eating, and has lost weight. She states foods have an unusual taste and are not appealing. On detailed examination, she is found to have normal extraocular movements, normal facial muscle symmetry, and normal facial sensation and swallowing. On further detailed examination, she has a loss of taste sensation in the right anterior two-thirds of her tongue. Of the following, which is the most likely area of injury?
A 56-year-old woman with recent open-heart surgery develops sudden onset, painless right eye vision loss. On funduscopic examination, the optic disc appears swollen and pale. No other significant findings were appreciated on the funduscopic exam. Damage to which of the following structures is the most likely cause of the patient’s symptoms?
A 67 y.o. female with HTN and atrial fibrillation on coumadin was in the Neuro ICU in a comatose state after a large intracranial hemorrhage. After a couple of days of monitoring, she had a new finding on her physical exam that prompted stat imaging, which showed signs of uncal herniation. Surgery was not performed due to goals of care preferences, and she, unfortunately, passed away from her ailment. An autopsy was requested. The image below shows compression on a cranial nerve from the herniation. Through which anatomic structure does this nerve pass to exit the skull?
Which of the following transverses through the structure (blue arrow) shown below?
A patient with medically refractory epilepsy secondary to mesial temporal sclerosis recently had a right hemispheric anterior temporal lobectomy. He is complaining of a post-operative visual field deficit. Which of the following is most likely to be appreciated on the exam?
Which of the following findings on a Head-Impulse-Nystagmus-Test-of-Skew (HINTS) test is consistent with central vertigo?
Paralysis of the stapedius muscle can occur with ipsilateral damage to which cranial nerve?
Which of the following cranial nerves is most likely to be affected by increased intracranial pressure?
A 65-year-old male with a history of alcoholic cirrhosis presents to the emergency department with dark black coffee-ground emesis. He is found to have a systolic blood pressure of 76/40 and is tachycardic to 120 BPM. Which nerve is most responsible for carrying the afferent fibers from carotid sinus baroreceptors that cause the reflex increase in heart rate seen in this patient?
A 59-year-old woman presents to the emergency room with dizziness and left ear fullness. The symptom is described as a spinning sensation that is present at rest and with action. She has had comparable events before, which have self-resolved over time. The patient is ataxic on the exam and has difficulty hearing out of her left ear. An MRI brain with and without contrast was normal. Which of the following is the most appropriate line of therapy that will decrease the risk of future recurrent events?
Which of the following symptoms is unlikely to be caused by a lesion in the cavernous sinus?
A 45-year-old patient presents with complaints of new-onset double vision. On the general neurologic exam, you note the patient tilts their head to the left. The remainder of the physical exam is unremarkable. Which of the following is the most common underlying pathologic cause of this issue?
Identify the structure (blue arrow) shown below:
Which of the following muscles is innervated by the vagus nerve (CN X)?
A 65-year-old woman with a history of a known right posterior communicating artery aneurysm comes to the emergency department with focal neurological symptoms. Brain MRI shows interval enlargement of the aneurysm. Which of the following clinical symptoms is most likely?
A 62-year-old woman presents to your clinic with complaints of dizziness. She states that about 2 weeks ago she had some dental work done including a root canal, and ever since then has had spells of extreme dizziness. She describes that the room spins and she becomes sick to her stomach. The sensation is improved by sitting very still. It completely resolves in between episodes, and episodes happen about once or twice a day. She noticed that it happens consistently when she tries to back out of the driveway in the early morning. She had a CT head one day ago that was read as normal. On exam, she has inducible nystagmus. The otoscopic exam is normal. Which of the following is the most accurate statement?
Which of the following is characteristic of a left internuclear ophthalmoplegia?
A 25-year-old female presents with anisocoria; her right eye is significantly more dilated when compared to the left eye in ambient light. The right pupil is also irregular in shape, does not respond to light, and is sluggish to constrict to near accommodation. When dilute pilocarpine (0.125%) is administered to the right pupil it constricts but the left eye doesn’t react at all.
Which of the following is the most likely cause of the patients’ symptoms?