0 of 100 Questions completed
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading…
You must sign in or sign up to start the quiz.
You must first complete the following:
0 of 100 Questions answered correctly
Time has elapsed
You have reached 0 of 0 point(s), (0)
Earned Point(s): 0 of 0, (0)
0 Essay(s) Pending (Possible Point(s): 0)
A 33-year-old female presents to the clinic for evaluation of a left lower extremity foot drop. On physical examination, there is weakness in dorsiflexion. Ankle eversion, inversion, and plantar flexion strength are normal. Hip abduction strength is normal as well. Which of the following is the most likely etiology for the patient’s symptoms?
A 26-year-old female presents with unilateral vision loss. She says that she noticed symptoms upon awakening yesterday morning and it has gotten progressively worse since then. On neurological examination, she has 20/70 visual acuity of the left eye and 20/20 of the right. There is a left afferent pupillary defect (APD). Extraocular movements are intact but cause pain. What is the most likely etiology of her symptoms?
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?
Which of the following findings is depicted in the catheter angiogram shown?
Which of the following medications is an acetylcholinesterase inhibitor that is FDA approved in the U.S. for the treatment of severe Alzheimer’s disease?
Which of the following statements regarding Alexander’s disease is incorrect?
Which of the following is not a recommended screening test for cognitive dysfunction?
A 39-year-old male presents to the clinic for hallucinations. His medical history is only remarkable for a chemical accident at his job resulting in severe corneal scarring bilaterally, for which he now requires a seeing-eye dog.
His hallucinations are usually of tall figures dressed in black with long fingers. He is not frightened by this because he knows they are not real. He denies other neurologic deficits, denies auditory hallucinations and describes his mood as “good”. The rest of his exam is normal.
You are familiar with the underlying syndrome the patient is experiencing. You inform the patient that in the rest of the population the most common cause of this syndrome is actually…
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 35-year-old male presents to the neurology clinic for the management of seizures. The patient reports having focal to bilateral tonic-clonic seizures (FTBTC) since the age of 15. His seizures are usually preceded by the smell of burning rubber. He will then have left hand automatisms followed by whole-body tonic-clonic activity. Levetiracetam monotherapy was initially effective. However, 1 year ago seizures returned, occurring once every two months. Lacosamide was added 6 months ago but there has been no significant improvement in his seizure frequency. Levels of these two anti-seizure medications (ASMs) are therapeutic and there have been no concerns regarding medication adherence. What is the most appropriate next step in management?
A critically ill 1-month-old has cerebral vessel imaging performed and shown below. Which of the following comorbid medical issues are likely present?
A 16-year-old girl is seen in the clinic for episodes concerning for seizures. Episodes are characterized by staring off, unresponsiveness, and licking her lips for 30 to 60 seconds. Two weeks ago one of these episodes developed into a generalized tonic-clonic seizure. That day she went to the emergency room and had an MRI performed. The associated images are shown below. Based on the clinical history and imaging what is the most likely diagnosis?
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?
A 30-year-old male presents to the clinic with a fifteen-year history of progressive weakness and sensory loss in his lower extremities. Examination shows hammertoes, high arches on his feet, 4/5 ankle dorsiflexion strength, and a mild decrease in sensation to pinprick in the 1st toes bilaterally. Upon questioning he mentions that his father had similar-looking feet and started to use a cane in his fifties. What is the most likely diagnosis for his symptoms?
A 23-year-old female with a past medical history of depression presents with right arm paralysis that started after she found out her boyfriend died from a motor vehicle accident. Her physical exam shows no effort during muscle strength testing and positive withdrawal when a noxious stimulus is applied. The rest of the neurological examination, including reflexes, was normal. MRI of the brain and cervical spine were unremarkable. Which of the following is the most likely diagnosis?
Sleep spindles are first seen at what gestational age (GA)?
A 40-year-old woman with a history of neurofibromatosis type 2 is presenting to the clinic with chronic anosmia and progressive left eye vision loss. Visual acuity testing reveals 20/200 OS and 20/20 OD. There is a left eye afferent pupillary defect. Funduscopic examination shows pallor of the left optic disc and blurring of the disc margins of the right optic disc. An MRI brain is ordered to localize the lesion. Based on the clinical examination, where will the pathologic lesion most likely be found?
A 27-year-old woman comes to the clinic for a routine checkup. She appears shy and does not make much eye contact. She mentions that she doesn’t have many friends because feels like she doesn’t deserve them and is fearful of rejection. She has had some depressive episodes in the past, but “does not want to bother anyone” about it. Which of the following is the most likely diagnosis?
A patient with a clinical history concerning for hydrocephalus has an MRI brain completed (see below). Surgical resection was completed and genetic analysis revealed no presence of an IDH mutation or 1p/19q co-deletion. What is the most likely diagnosis?
Which of the following anti-seizure medications carries the highest risk of major congenital malformations?
Which of the following is the antibody associated with dermatomyositis that is known to confer the highest risk of cancer?
A 24-year-old male with no known past medical history experienced a first-time generalized tonic-clonic seizure while at work. She is now in the emergency room and back to her neurological baseline. Bloodwork was unremarkable. A routine EEG and MRI of the brain were normal. Which is the most appropriate next step in management?
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 5-year-old male presents because of muscle stiffness. His symptoms are worse during the colder winter months and with gym class at school. He sometimes becomes so stiff he can hardly breathe. Examination shows no muscle atrophy or hypertrophy but myotonia is present. Upon further questioning, you learn he has an older brother with similar symptoms. What is the likely dysfunctional gene in this patient?
Optic nerve glioma is associated with which of the following diseases?
A 45-year-old male with a history of IV drug use, HIV, and medication non-compliance is admitted to the hospital with a two-week history of headache, fever, malaise, and double vision. His most recent CD4 count was 180. Lumbar punction is performed. CSF analysis with India ink strain shows encapsulated yeast. Which of the following is the most likely cause of the patient’s symptoms?
Which of the following syndromes are most likely associated with the lesion shown in the image below?
You are caring for a 65-year-old that sustained a small hypertensive intracranial hemorrhage. Early physical therapy is initiated. They discover that while she can sit unassisted, she is unable to stand. When standing, she sways and falls forward, backward, or to one side. On a detailed physical exam, strength is 5/5 to flexion and extension at the ankle, knee, hip, shoulder, elbow, and wrist bilaterally.
Which of the following locations of the bleed best explains this finding?
A 35-year-old Dominican Republic immigrant is brought to the emergency room for a first-time seizure. He is currently back to baseline and has a normal neurological exam. His only complaint is a multiple-month history of chronic headaches. A head CT scan is performed and shown below. Which of the following is the most likely etiology of his symptoms?
Identify the pathological abnormality shown in the image below.
A 62-year-old woman with a history of rheumatoid arthritis presents with insidious onset of painless proximal muscle weakness and atrophy. A serum CK is obtained and is normal. TSH is also normal. Her medication list includes lisinopril, aspirin, and prednisone. EMG shows short-duration motor unit potentials in the deltoids and quadriceps bilaterally. A muscle biopsy is performed. Which of the following will most likely be appreciated?
A 12-year-old boy with a past medical history of sickle cell disease was admitted to the emergency room in a pain crisis. While being treated with morphine the patient developed acute left arm/leg weakness and numbness. Which of the following is the most likely etiology for the patient’s new neurologic symptoms?
You are asked to evaluate a patient in the neurointensive care unit who is comatose and has had a somatosensory evoked potential performed. Which of the following is most suggestive of a poor prognosis for this patient?
A 32-year-old male comes into the headache clinic for severe headaches. They occur several times a day and last approximately one hour. They are only felt on the left side of his head, and he says he gets a runny nose and a little teary during the episodes. What is a notable side effect of the prophylactic medicine that is considered first-line therapy for this condition?
A 7-year-old boy with no significant past medical history presents to the clinic after declining school performance and daydreaming. A routine EEG is performed and shown below. Which of the following medications is the most appropriate first-line therapy?
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?
The medulla is an embryologic derivative of which of the following structures?
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?
Which of the following can not cross the blood-brain barrier via channel-mediated transport?
Identify the structure labeled 4 in the angiograms provided below.
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?
Immunohistochemical staining with GFAP is particularly useful in identifying which of the following cell types?
A 56-year-old man with a past medical history of hypertension and type II diabetes presents to the hospital with acute onset left-sided weakness which started 90 minutes prior to your evaluation. His only medications prior to admission were metformin and verapamil. Vitals were within normal limits except for a blood pressure of 154/92. Physical examination reveals 3/5 weakness in the left arm, leg, and face as well as a moderate sensory disturbance in the same regions. CT head was unremarkable and CT angiogram (CTA) showed no large vessel occlusion. A brief history gathered from his wife revealed no other comorbidities or active medical issues. At this point in his clinical presentation, what is the mechanism of action of the most appropriate therapy?
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?
An EMG/NCS is performed for the evaluation of subacute left upper extremity weakness in an adult female. There are fibrillation potentials in the deltoid and biceps on EMG and decreased median and radial sensory amplitudes on NCS. Which portion of the brachial plexus was injured?
A patient with end-stage amyotrophic lateralized sclerosis (ALS) presents to the emergency room from a nursing home alone. His vitals show hypoxemia and he appears tachypneic on examination. On examination, he is also paraplegic with significant weakness in the upper extremities and mild dysarthria. His mental status examination appears intact. Between short breaths, he says that he does not wish to be intubated. This is consistent with the end-of-life discussions documented in the outpatient clinic notes. As his hypoxemia worsens his wife arrives at the bedside and with urgency asks you to intubate the patient. What is the most appropriate response?
A 45-year-old patient presented to the emergency room unresponsive. Emergency medical services noted that the patient was found in his garage with the car running in an apparent suicide attempt. Despite appropriate medical care, the patient passed away. An autopsy was performed. A gross pathology image is shown below. Identify the following regions marked by the white arrows.
A 12-day-old male is brought to the pediatrician by his mother with a two-day history of rash. The child was born full-term to a G2P2 mother with good APGAR scores. On physical exam, the pediatrician notes that the child has a pink, crusting, maculopapular rash over his buttocks, thighs, and soles of his feet. She states that a week after his birth he had the “sniffles” and a lot of white discharge from his nose. On exam, there is hepatomegaly and generalized lymphadenopathy. Which of the following is the most likely cause of the patient’s symptoms?
What is the pathophysiology of the lesion provided below?
A 61-year-old male with a past medical history of GI cancer status post gastric resection at age 57, consequently on parenteral nutrition, presents to your clinic for a second opinion. He complains of slow movements and rigidity in his arms and legs that have slowly progressed over the last year. He denies tremors or cognitive change. He saw a different neurologist who started him on carbidopa/levodopa 6 months ago but the response has been minimal and he continues to get worse. You decide to perform a brain MRI and you see bilateral hyperintensity of the globus pallidi on the T1-weighted image. What treatment should you add?
A 42-year-old woman with multiple sclerosis presents to the ER after having worsening confusion over a few days with worsening weakness and vision loss. She was on natalizumab for years and her most recent JCV antibody titer was negative. She has missed several months of infusions due to her helping a sick relative. Her MRI shows multiple new T2 hyperintensities with enhancement in the periventricular and subcortical white matter. What is the most likely diagnosis?
A 54-year-old male with hypertension, hyperlipidemia, and atrial fibrillation on warfarin is newly diagnosed with epilepsy. Of the following medications, which is the most appropriate anti-seizure medication to prescribe?
A 67-year-old male wakes up with a painful, right-sided, itchy rash coming across his abdomen like a band involving the umbilicus. His primary care provider is concerned that the patient has shingles. For this patient, re-activation of the varicella-zoster virus occurred at the dorsal root ganglion at which thoracic level?
What is the anatomical structure marked by the blue arrow?
Which of the following seizure characteristics are typically seen in patients with temporal lobe epilepsy?
A 55-year-old female with a past medical history of coronary artery disease and ischemic stroke with residual mild left arm weakness presents with headaches for a year. Episodes occur two to three times a month. The pain is unilateral and is associated with nausea and photophobia. During this episode, she is unable to go to work and over-the-counter anti-inflammatories have been ineffective. Physical exam and vitals are normal. Which abortive therapy is the most appropriate next step in management?
A 39-year-old male presents with right-sided weakness and aphasia. NIHSS is 22 on physical exam. He was last known well 2.5 hours prior. The past medical history does not reveal any contraindications to tPA. A CT head is done and shows a hyperdense left MCA sign. The tPA is mixed by the nursing staff while you consent his wife for its administration. When you return to the bedside his aphasia has improved but his NIHSS is still 13. The blood pressure is 189/105 and the glucose is 225. What is the most appropriate next step?
A 4-month-old boy is brought by his parents due to difficulty in feeding, and episodes of apnea. Physical examination reveals tongue fasciculations, a bulging anterior fontanelle, and an abducens nerve palsy. MRI reveals an Arnold Chiari malformation type II. What additional defect is this child likely to have?
Match the phase of the Valsalva maneuver with its associated physiology.
Which of the following structures is not primarily involved in the processing and relay of auditory information in the central nervous system?
Which of the following regions of the brain, when active, promotes the switch from drowsiness to non-REM sleep?
Which of the following nerve conduction study abnormalities is least likely to be seen during the initial phase of acute inflammatory demyelinating polyneuropathy (AIDP)?
This muscle biopsy is most consistent with which myopathic disease?
A thin 28-year-old male presents to the clinic with complaints of foot drop. On exam, he has a right foot drop as well as numbness on the lateral aspect of the right lower leg. You suspect compression of a nerve at the fibular head. Malfunction of which of the following nerves causes the foot drop itself?
A 78-year-old male with a past medical history of diabetes presents to the clinic with a 2-year history of progressive lower extremity numbness and pain. He describes the pain as “pins and needles”. Physical examination reveals loss of pinprick sensation to the ankles bilaterally, mute Achilles reflexes, and moderate difficulty with tandem gait. A diagnosis is made based on examination and clinical history. What is the mechanism of action of the most appropriate first-line therapeutic agent?
A 26-year-old physics teacher and mother on valproic acid (VPA) for epilepsy presents to your clinic with her husband stating she wishes to try to become pregnant soon. She asks how anti-seizure medications (ASMs) used during pregnancy may impact the intelligence and school performance of her child. Which is the most accurate response?
Patients with neurofibromatosis type 1 (NF1) classically have which of the following associated with their disease?
Which of the following structures is well myelinated in a full-term (40-week) infant?
A 46-year-old male with a 2-month history of progressive headache and behavioral changes presents to the ED after experiencing a first-time seizure. An MRI was performed and shown below. A brain biopsy confirmed the diagnosis when it found pseudopalisading necrosis and microvascular proliferation. Which of the following treatment(s) is the standard of care for this patient?
A patient presents to the emergency room with sudden onset weakness and dysphagia. On exam, the patient’s tongue deviates to the left, and there is right hemiparesis and right-sided loss of position and vibratory sensation. Pain and temperature sensation is intact. Which of the following arteries supplies blood to the damaged area?
Which of the following is not typically treated with indomethacin?
Paraphasic and semantic errors in speech can occur secondary to a lesion in which of the following regions?
Which of the following is NOT known to cause a drug-induced tremor?
An 85-year-old man with memory issues donates his brain for research on neurodegenerative disease. A histopathologic, Bodian-stained, sample of his brain tissue is shown below. Based on this image provided, what was the patient’s most likely neurodegenerative diagnosis?
A 40-year-old male presents to the clinic with difficulty swallowing. On additional questioning, he reports difficulty walking, falls, and dysarthria. Examination shows bilateral facial weakness, fasciculations, and gynecomastia. A CAG trinucleotide repeat on which of the following genes is the cause of this disease?
A 34-year-old man with medically-refractory epilepsy has an MRI brain completed. The lesion shown (T2 sequence) does not enhance with contrast. If a surgical resection was performed, which of the following would be the most likely seen on pathologic analysis?
A neurology consult is placed on a full-term newborn male after being delivered by an uncomplicated vaginal delivery with good APGAR scores. The physical exam reveals a midline lesion in his lumbar region. Based on the pathology shown below, which of the following would most likely also be present on head imaging?
A previously healthy 25-year-old female presents to the emergency room with lower extremity weakness, numbness, and urinary retention. Lower extremity hyperreflexia and a sensory level at T10 were appreciated on examination. A contrasted cervical/thoracic and lumbar MRI was performed and shown below. Lumbar puncture was performed after imaging was completed and showed an elevated protein concentration, normal glucose, 3 WBCs, and oligoclonal bands. Rheumatologic studies are negative. Based on the most likely diagnosis, what is the most appropriate next step in medical management?
A 57-year-old navy veteran with a history of PTSD presents with a 2-year history of progressive, asymmetric weakness. The patient states that symptoms started in his left arm. Six months later he started to have falls due to tripping over his right foot. His neurological examination shows weakness of the intrinsic hand muscles of the left arm, ⅖ strength on dorsiflexion of the right ankle, and no sensory disturbances. Reflexes were mute in the left upper extremity and there were several beats of clonus at the right ankle. Fasciculations were present in the tongue, right gastrocnemius, and left tibialis anterior. An EMG is recommended for diagnosis. Which of the following EMG findings are most likely seen in this patient?
A 2 month-old female is brought to the emergency room by her mother after she noticed abnormal movements concerning for possible seizure. The child was born at term and was the product of a normal pregnancy and delivery. While gathering a history, the child is lying on the bed still when you notice repetitive movements of his bilateral lower limbs. When her mother notices she picks up the patient and the movements resolve. What is the most likely diagnosis?
Which of the following botulinum serotypes cleaves synaptosomal-associated protein (SNAP)-25.
A 68-year-old male with a 10-year history of Parkinson’s disease comes to the clinic for routine follow-up. He currently is taking levodopa/carbidopa, entacapone, and ropinirole. The patient is complaining of significant dyskinesias and unpredictable motor fluctuations between doses of levodopa/carbidopa. What is the most appropriate next best step in management?
A 27-year-old man presents after having an unprovoked generalized tonic-clonic seizure. Which of the following should he be told regarding his clinical situation?
A 29-year-old man with a 10-pack-year smoking history comes into the clinic with a severe headache. The pain surrounds his right eye and is associated with a runny nose, excessive tearing, and a “droopy eyelid.” He describes the pain as stabbing that usually lasts about 30 minutes and occurs every day after he eats dinner. What is the most likely diagnosis?
You are caring for a 19-year-old male in the neurocritical care unit after drowning. His brain MRI is pending clinical stability. Which finding on brain MRI is most likely after a severe global hypoxic injury?
Which of the following cranial nerve(s) transverses through the structure (blue arrow) shown below?
Narcolepsy is associated with which of the following HLA alleles?
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?
Which of the following identifies the sigmoid sinus?
A 65-year-old woman with a past medical history of hypertension presents with recent onset of bilateral eye discomfort and diplopia. She states that she is unable to completely close her eyes. On exam, pain is elicited when testing extraocular movements. Visual acuity and visual fields are unremarkable. MRI of the brain reveals excessive peri-orbital subcutaneous tissue bilaterally. Which of the following is the most likely diagnosis?
Which of the following comorbidities are responsible for the lesion appreciated in the image below?
A 7-month-old girl with a past medical history of hypotonia, weight loss, and failure to thrive is brought to the clinic by her parents. An MRI was performed and T2 sequence images from this study are shown below. What is the most likely diagnosis?
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?
The usage of bupropion increases the risk of which of the following?
A 40-year-old male is referred to the clinic for a one-year history of progressive weakness of the upper and lower extremities. Past medical history is impressive for thrombocytopenia, anemia, and hepatosplenomegaly. Neurological examination shows 2/5 strength in the distal lower limbs bilaterally with diminished ankle and patellar reflexes. The sensory exam shows diminished vibratory and pinprick sensation in both legs. He also has a markedly orange discoloration of his tonsils. Genetic testing is performed which reveals a mutation in the ABCA1 gene. Which of the following is the most likely diagnosis?
What is the mechanism of action of pregabalin?
Which of the following is the most sensitive test for myasthenia gravis (MG)?
Which of the following vessels that supply the thalamus originates from the P2 segment of the posterior cerebral artery and supplies the lateral geniculate nucleus?
A 40-year-old textile worker is brought to the clinic for slowly progressive symptoms including shuffling gait, tremor, and profuse drooling. On examination, his speech is difficult to understand and there is cogwheel rigidity in his arms and legs. His tremor is most evident when his limbs are at rest. Exposure to which of the following is the most likely cause of the patients’ symptoms?
Of the following, which extraocular muscle is not innervated by the oculomotor nerve?