Quiz 06/03/2022 (1)

Which of the following nerves is a terminal branch of the posterior cord?

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

A 77-year-old male presents with a 1-year history of worsening bradykinesia, recurrent falls, and a shuffling gait. Past medical history is significant for REM-sleep behavior disorder and diet-controlled hypertension. Neurologic examination reveals a tremor at rest that improves with movement, along with bilateral upper-limb rigidity. Impaired dopaminergic signaling is most likely to be found in which of the following locations?

A 36-year-old man with no significant past medical history presents with lower back pain, lower extremity weakness, and urinary incontinence. A non-contrast enhancing lesion was found on lumbar MRI (T1 sequence without contrast image shown below). What is the most likely diagnosis?

A 19-year-old boy presents with his mother for complaints of frequent eye blinking and shoulder-shrugging spells occurring multiple times a day. He also has frequent episodes of humming a three-note tune randomly throughout the day. He has had these problems since he was 17. He had an MRI brain and EEG that were negative. He takes no medications. The symptoms do not impact his activities of daily living, but he does feel embarrassed by the symptoms. He went to cognitive behavioral therapy for this for a year and has not seen a benefit. Which of the following is a first-line medication for this patient?

Identify the electrographic pattern appreciated at electrode P3 in the EEG below:

A 38-year-old female presents to the clinic with episodes of facial pain. She reports episodes of sudden severe and debilitating sharp pain on her right face lasting a few seconds to a couple of minutes. These seem to be triggered by eating or lightly touching the face. Outside of these episodes, she is pain-free. She does not endorse any associated rhinorrhea, lacrimation, or facial flushing. What is the likely cause of her symptoms?

A 4-year-old boy with a history of mild cerebral palsy comes to the clinic for his annual follow-up. Since last seen in the clinic the patient and family have noted that he has been having increased difficulties with his left leg. Most days he is able to ambulate with a hand-held mobility device. However, more recently family has noticed that he not walking as much as he used to. On examination, there is increased spasticity and hyperreflexia at the ankle. The right leg had normal strength and tone. What is the most appropriate therapy for the patient’s symptoms?

A 50-year-old female presents with altered mental status. Her family states that over the past couple of weeks, the patient has had progressive memory loss, mood changes, and poor judgment. On examination, the patient has involuntary arm movements and an exaggerated startle response. Brain MRI, DWI sequence, is shown below. Which of the following is the most likely diagnosis?

Based on the histopathologic findings shown below, how long ago did this patient experience an ischemic stroke?

Identify the finding shown in the EEG below:

Which of the following is a necessary requirement for electrocerebral inactivity (ECI) testing?

A 50-year-old Caucasian woman with no past medical history is admitted to the psychiatric hospital after trying to jump from a moving bus. She reports the other passengers were laughing at her in their minds, and trying to steal her thoughts. Upon arrival to the psychiatric floor, she is witnessed to have sudden left eye deviation with right arm twitching for a few seconds before turning her head, screaming loudly, and falling to the floor with full-body convulsions, lasting 2 minutes.

You, the attending neurologist, are consulted to help evaluate. On exam she is easily distractible, looking to the corners of the room for security cameras. You contact her husband who states she has never had any problems like this before, but she has gone downhill over the last 3 weeks, forgetting people and places, repeating herself, and acting strangely.

Lab evaluation reveals normal CBC, BMP, TSH, T4, free T4, and T3. The comprehensive drug screen is negative. MRI brain w/ and w/o contrast is normal appearing. Lumbar puncture is with 18 cmH20 opening pressure, 0 WBCs, 1 RBC, 50 protein, and 55 glucose. The autoimmune panel is sent and anti-microsomal antibodies are elevated. What is the most likely diagnosis at this time?

This muscle biopsy is most consistent with which myopathic disease?

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 EEG pattern on this bipolar EEG recording is most consistent with which of the following epilepsy syndromes?

A 14-year-old girl with no significant past medical history presents with an acute presentation of left-sided weakness. CTH was negative but MRI shows an acute lacunar ischemic stroke in the right hemisphere. An angiogram was performed which revealed segmental arterial constriction followed by segments of arterial dilation in multiple intracranial vessels. Which of the following is the most likely etiology of her ischemic stroke?

A 56-year-old man with a history of a kidney transplant, on tacrolimus, presented to the hospital with a 2-week history of progressive confusion and expressive aphasia. An MRI brain with and without contrast was performed and shown below. A brain biopsy was performed and showed microglial nodules with encysted bradyzoites and tachyzoites. Which of the following is the most appropriate therapy?

A patient with an unclear history of epilepsy has an EEG performed. Based on the region of her epileptiform activity, what is the most likely semiology of her clinical seizures?

A 60-year-old woman with a history of diabetes is presenting to the neurology clinic with a 4-month history of burning/tingling in her bilateral toes. Neurological examination revealed 5/5 strength in all muscle groups, normal reflexes, and intact sensation to light touch in the bilateral lower extremities. There was mildly decreased sensation to pinprick in the 1^st toe bilaterally. Which of the following tests is the most likely to be diagnostic for this patient?

A 35-year-old male with balance issues is referred for an EMG/NCS. Distal sensory loss of the feet, high-arched feet, and diffuse hyporeflexia are appreciated on the exam. His nerve conduction studies are shown below. Based on the available information what is the most likely diagnosis?

A 40-year-old woman is hospitalized at an inpatient psychiatric facility for new behavioral disturbances and a suicide attempt. She has also begun to develop unusual movements of her bilateral upper extremities. The movements are non-rhythmic, high-amplitude, low-frequency, and involve the entire extremity. Her brain MRI is shown below. Which of the following may help to treat her movements?

A 37-year-old female with a past medical history of chronic fatigue and heat intolerance presents with right arm weakness. A cervical spine MRI is performed and shown below (Left: T2 sagittal. Right: T2 axial). Which of the following is the most likely diagnosis?

Which of the following arteries supplies the lumbar spinal cord?

Hyperammonemia is a side effect seen with which of the following antiepileptic drugs?

A 6-month-old boy with no significant past medical history is brought to the clinic by his father because of abnormal limb movements that occur multiple times a day. His father describes high-frequency, low amplitude rhythmic movements that start in the child’s head and quickly spread down the shoulders. Episodes last approximately 1-2 seconds. There are no clear triggers and there is no loss of consciousness associated with the events. Family history is significant for essential tremor in the patient’s mother. Which of the following is the most likely diagnosis?

A 68-year-old man with left leg weakness and pain has an MRI performed to evaluate for a possible etiology. Her imaging is provided below. Based on the location of the lesion, which of the following muscles is most likely weak on examination?

Which of the following is the relay center for sensory information of the body?

The combination of lamotrigine and which of the following drugs increases the risk of lamotrigine toxicity?

A 65-year-old man presents to the emergency room with progressive weakness over the course of several months. Examination shows pure motor weakness with no sensory involvement, decreased reflexes, and diffuse fasciculations. An EMG shows conduction block of motor neurons outside of compression sites and normal sensory conduction velocities. Which of the following antibodies is associated with this disease?