Quiz 06/01/2022

A 45-year-old female with a past medical history significant for asthma presents to the clinic for migraines with aura. Her headaches occur at least 13 times a month. She was given sumatriptan for abortive therapy six months ago but it has become ineffective. Her vital signs are stable. Her BMI is 33. Which of the following is the best next step in treatment?

A 7-day-old infant is in the hospital since birth when he starts having seizures. He has been feeding poorly thus far. On examination, he has hypotonia, as well as distinctive facial features of midface hypoplasia, hypoplastic supraorbital ridges, and a prominent high forehead. The metabolic testing panel returns with elevated very-long-chain fatty acids. What is the physiology of this disorder?

Which of the following identifies the vein of Galen?

A 37-year-old retired nurse is being evaluated in the emergency room for excessive diarrhea. She has been in the emergency department multiple times in the past for similar complaints and diagnostic testing has repeatedly been unremarkable. While casually talking to the nursing staff, the patient accidentally knocks over her purse and several bottles of laxatives fall out. Which of the following is the most likely diagnosis?

The trochlear nucleus sends nerve fibers to which of the following muscles?

A 32-year-old man with a past medical history of major depressive disorder is brought to the emergency department by his roommate who states that a few days ago the patient stopped taking his medications. Vital signs were within normal limits. On examination, the patient was non-verbal except for occasionally repeating words spoken by the examiner. He would not follow commands. When his arms were positioned off the bed they remained there for several minutes. CT head and CTA of the head and neck were normal. Which of the following is the most appropriate next step in treatment?

A 34-year-old man was admitted to the hospital and intubated after a severe motor vehicle accident leading to multiple bone fractures two days ago. Despite weaning IV sedation, the patient continues to be unarousable to stimulation. An MRI was performed and DWI imaging is shown below. What is the most likely diagnosis?

A 23-year-old female with a history of optic neuritis presents with a 1-week history of left leg weakness. Neurologic examination reveals decreased strength of the left lower extremity. A lumbar puncture reveals oligoclonal bands with lymphocytic pleocytosis. What stain can be used to identify the dysfunctional cells in this condition?

A 36-year-old woman presents with facial weakness. She states that symptoms started on the right side of the face one week ago, but since then the left side has also become progressively weak. Other pertinent complaints include dry cough, shortness of breath, and joint pain. MRI of the brain shows bilateral contrast enhancement of the facial nerves. Chest X-ray reveals bilateral hilar adenopathy. A diagnostic lymph node biopsy is performed. Which of the following is most likely appreciated on pathologic analysis?

A 45-year-old female who is a professional pianist was referred to the EMG lab for right-hand numbness and tingling. Based on the EMG data outlined below where is this patient’s pathological lesion?

A 25-year-old woman with no significant medical history comes to the clinic for a routine physical exam. During the interview, she states that she is in a relationship with a famous singer for the last three months. She says his song lyrics are about her and his social media contains hidden messages that only she understands. The singer recently filed for a restraining order, but the patient says that’s “just for show.” She works at a local coffee shop and just recently got a promotion to manager. She denies any drug or alcohol use and takes no medications. Which of the following is the most likely diagnosis?

Match the phase of the Valsalva maneuver with its associated physiology.

Which of the following is the mechanism of action for aducanumab?

A 57-year-old male with a past medical history of progressive weakness affecting all extremities and dysphagia for the past 6 months is admitted to the hospital. An EMG was completed as part of his workup and is shown below. Based on the available information what is the most likely diagnosis?

What is the pathophysiology of the lesion provided below?

Which of the following is classically seen on electromyography in a patient with an acute neuronal injury?

In normal neonatal development, which of the following structures myelinates the latest?

Which of the following findings is depicted in the catheter angiogram shown?

A 32-year-old male with a longstanding history of epilepsy secondary to mesial temporal sclerosis returns to your clinic. Despite being on appropriate doses of levetiracetam and valproic acid he continues to have 20 partial seizures and 4 generalized tonic-clonic seizures per month. Which of the following is the next best step in his care?

A 53-year-old male presents with a 3-month history of hypersexuality, visual agnosia, excessive chewing, and lip-smacking. Past medical history is notable for HSV encephalitis 6 months ago, which was treated with IV acyclovir. Based on the clinical history and examination, which of the following would most likely be appreciated on a brain MRI?

An 18-year-old woman presents as a new patient to your clinic for “seizures”. On review of her medical records, you find that she has had numerous ED visits and inpatient admissions for generalized shaking spells. Several of them have been captured on video EEG recording and there was no EEG correlate with the behavior, suggesting that they are psychogenic non-epileptic attacks/spells (PNEA/PNES). She says she is seeing you today because “I need someone to refill my seizure medications.” Which of the following basic principles of medical ethics could be best applied to this scenario?

Identify the lesion shown in the image below.

A 47-year-old female presents to the clinic with the chief complaint of slowly progressive proximal muscle weakness. Electromyography showed short duration, low amplitude motor unit action potentials. A muscle biopsy was performed and shown below. A diagnosis is made and the patient is started on a therapeutic agent. What is the most likely medication initiated?

Which of the following is correct regarding the H-reflex?

A 26-year-old female with a past medical history of pulmonary embolism presents with seizures and left-sided weakness. She had been complaining about a headache for the past week. An MR venogram is shown below. Which of the following is the next best step in management?