Quiz 05/30/2022 (2)

Which of the findings are most likely to be found on examination in a patient with the lesion appreciated in the image below?

This muscle biopsy is most consistent with which myopathic disease?

A 68-year-old right-handed male with HTN and atrial fibrillation formerly taking Eliquis, but stopped months ago due to GI bleed, presents for acute onset neurologic symptoms. He is able to understand speech and commands, however, he is unable to speak fluently and can not get the right words out. Despite this, he is able to accurately repeat words you say and correctly name items that are pointed to. What other neurologic symptom is also likely to be present on the exam?

A 35-year-old woman presents to the clinic with headaches. Her past medical history is significant for migraines and a sprained ankle four months ago that she has been managing with daily NSAIDs. Her headaches started a month ago and have been occurring every day for the past three weeks. She describes the headaches as a band-like pressure around her head. Nothing has helped but the symptoms are worse in the mornings. A recent brain MRI was completed during an emergency room visit which was unremarkable. Which of the following is the most appropriate next step in therapy?

The pathology shown in the image below is likely secondary to which of the following?

Aquaporin-4 (AQP4) channels are found on which cell type?

Which of the following medications used in the management of attention deficit hyperactivity disorder (ADHD) can worsen comorbid Tourette syndrome if present?

A 79-year-old woman presented with the acute onset of difficulty walking and nausea that started about 24 hours before presentation. Examination revealed left-beating nystagmus and left-sided appendicular and truncal ataxia. Her axial FLAIR MRI imaging is shown below. The pathology shown is seen in which of the following vascular territories?

Which of the following is present in the image shown below?

A 67-year-old male with a gait disorder is having a polysomnogram due to aggressive leg movements during sleep. During the study, an abnormality is noted during sleep. The EMG and chin leads show excessive muscle artifact during sleep, while at the same time the EEG shows quick deflections in the lateral leads, indicating rapid alternating eye movements. He is given a diagnosis and started on medication. Which of the following is the most appropriate treatment for this sleep issue?

A 65-year-old male is brought in by his daughter due to progressive headache and memory difficulties. MRI of the brain was ordered and is shown below (Left: T2 FLAIR, Right: T1 with contrast). A biopsy of the lesion would most likely reveal which of the following?

A 56-year-old male comes to the clinic with a burning and tingling sensation in his feet and hands for the past 4 months. He has a history of morbid obesity and underwent gastric bypass surgery last year. On physical exam, he has 3+ ankle and patellar reflexes. He also has a positive Babinski and positive Romberg sign. There is impaired position and vibration sense in his big toe bilaterally. This patient’s condition is most likely due to a deficiency of which of the following?

A 3-year-old male with a history of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) was referred to neurology by his PCP for concern of a genetic disorder. On examination, the patient appears to have a long face, large ears, and a prominent jaw. Genetic testing shows that the patient has a pathologic gene mutation with over 200 trinucleotide CGG repeats. Which of the following is a comorbidity appreciated in this patient’s neurologic syndrome?

A 5-year-old boy is seen in the clinic for seizures, vision loss, and progressive loss of milestones. MRI of the brain shows a posterior predominant leukodystrophy. Which of the following is the most likely diagnosis?

Which synapsed of the peripheral nervous system is acetylcholine the primary neurotransmitter?

A 32-year-old man with a past medical history significant for major depressive disorder is brought to the emergency department after he was found by his roommate attempting suicide by hanging. His roommate states that he has been noncompliant with his medications and had been going through a depressive episode before his suicide attempt. After 6 weeks of trying several different antidepressants while on the inpatient psychiatric service, his major depression symptoms have not improved. Which of the following is the most appropriate next step in treatment?

An 80-year-old woman with uncontrolled HTN presents to the ED with symptoms upon awakening of left hemi-sensory loss, last seen well 8 hours prior. MRI is done and shows a lateral thalamic lacunar stroke. The small branch affected in this lacune is most often a branch of which major artery?

Identify the lesion below.

A 24-year-old man comes to the emergency room with severe left-hand pain after a fall at home. The patient refuses to allow the nurse or doctor to do a physical exam. A hand X-ray is unremarkable. She insists that all she needs is a note for two weeks of paid leave from her job. Which of the following is the most likely diagnosis?

Initiating HAART therapy for a patient with poorly controlled HIV places them at an increased risk for which of the following?

A 17-month male was brought to the pediatric neurology clinic was brought to the clinic with concerns for developmental delay. Parents note that the child was a product of a normal pregnancy and his delivery was uncomplicated. A developmental delay was appreciated by 8 months of age. He is largely non-verbal. He appears happy in the room, laughing spontaneously without any external stimuli. Which of the following abnormalities most likely explains this developmental disorder?

A 32-year-old man was recently admitted to the stroke service for an intracranial hemorrhage secondary to an arteriovenous malformation. In addition to his acute focal neurological deficits, the following skin lesions are appreciated (see image below). A genetic syndrome is suspected. Based on the most likely clinical diagnosis, what is the risk of his son having the same condition?

An 82-year-old female patient with a history of atrial fibrillation is brought to the emergency department after being found down at home. She is unable to move her extremities, although she is able to blink and move her eyes vertically. Occlusion of which artery/arteries is the most likely cause of her symptoms?

A 30-year-old woman presents to the clinic with severe headaches requesting treatment because she “can’t live with this pain”. Episodes are left-sided, occur multiple times a day, and last about 20 minutes each. During episodes, she will also have eye tearing and rhinorrhea. What is the appropriate therapy?

A 65-year-old female patient presents with right homonymous hemianopsia for the past week. She also says she has difficulty reading but no problems with writing. Which of the following area of the brain is likely affected?

A 40-year-old male presents with a one-day history of numbness of his right arm. This has never happened before, but he does report an episode of left leg weakness that self-resolved two years ago. The neurological examination confirms a sensory disturbance of his right arm. Sagittal MRI of the cervical spine is shown below (Left: T1, Middle: T1 with contrast, Right: T2). Which of the following is the most likely diagnosis?

A 12-year-old male is brought to the clinic accompanied by his father who states that for the past 4 months he has been randomly flailing his arm during class and calling out in the middle of the teacher’s lectures. He has been sent to the principal’s office twice in the past month for his disruptions. His father states that this is very out of character for him. In the clinic, the patient has intermittent movements of his right arm, where he raises his arm above his head and then slaps it down on his leg. Additionally, during the exam, he blurts out words that do not make contextual sense in the conversation. Two months later, the patient follows up with his father who states that all of the abnormal movements and vocalizations have resolved. What is the most likely diagnosis?

A 32-year-old man with no significant past medical history presents to the emergency department after experiencing a generalized tonic-clonic seizure. His neurological examination was unremarkable. As part of his work-up, an MRI was obtained (see FLAIR axial image below). What is the most appropriate next step in management?

A 50-year-old male presents to the emergency room with a three-day history of double vision and difficulty walking. Neurological examination reveals decreased eye movements. Strength in the limbs is relatively preserved but all reflexes are absent. There is also marked limb clumsiness. Which of the following is the most likely diagnosis?