Quiz 06/06/2022

A 66-year-old patient with bradykinesia, hypomimia, dementia, postural instability, cogwheel rigidity, shuffling gait, and resting tremor presents to your clinic. He has been on carbidopa/levodopa for several years, which has helped, but now his wearing-off phenomenon is becoming more frequent despite attempted medication adjustments. He asks about deep brain stimulation (DBS).

Which of the following is a contraindication for DBS in Parkinson’s disease (PD)?

A 72-year-old female presents to the clinic with her husband who states that she is “seeing things that aren’t there”. For the past two weeks, she has been complaining of bats flying around her room at night. Comparable visual disturbances have occurred over the past year, but have gotten progressively worse recently. She has also been acting out a lot at night; her husband states that she has been violently kicking and flailing her arms while asleep. Finally, she has been experiencing cognitive decline, including forgetting where she lives, what year it is, and the names of her grandchildren. On exam, there is symmetric cog-wheel rigidity appreciated. What is the most likely diagnosis?

The imaging shown below is most consistent with which of the following diseases?

The vessel labeled 1 in the angiogram provided supplies all of the following structures EXCEPT:

A 4-year-old male with no significant past medical history presents to the emergency room after experiencing a first-time seizure. An EEG is obtained and captures a seizure arising from the left hemisphere and polymorphic delta slowing on the same side. Over the next several months the child continues to experience focal-onset seizures despite being on 2 maximally-dosed seizure medications. His brain MRI, below, shows asymmetric left-hemispheric atrophy. His clinic presentation and imaging are most consistent with which of the following diseases?

What findings would be found on EMG/NCS in a patient who presents with a small fiber neuropathy?

Which of the following is most likely to cause the pathology seen in the image below (white arrow)?

Deep brain stimulation has been FDA approved for the management of medically refractory epilepsy when it targets which of the following structures?

A 35-year-old woman with a past medical history of ocular and oral dryness presents with a 5-month history of progressive difficulties with ambulation. On exam, there is diminished vibratory sensation along the plantar/dorsal surfaces of her feet, 1+ ankle reflexes bilaterally, and a positive Romberg sign. Strength is normal. A tissue biopsy confirms the diagnosis. Which of the following is the most likely diagnosis?

Which of the following medications is the most appropriate pharmacologic agent for paroxysmal kinesigenic dyskinesia?

Which of the following is the mechanism of action of riluzole?

A 4-year-old boy is in the hospital for headache and abdominal pain and is being treated by the pediatric service for possible constipation, for which they have given polyethylene glycol. You are consulted due to the new onset of inability to extend his left wrist. On exam, you note a bluish coloration of the gingiva.

A peripheral blood smear is requested and shows microcytic RBCs with basophilic stippling. Anemia in this disease is caused in part by inhibition of which of the following?

A 68-year-old woman with a history of diabetes and hypertension presented urgently to the ED with a 2-day history of headaches and confusion. Before any imaging was able to be completed in the emergency room, the patient had a cardiac arrest and died. An autopsy was requested by the family. A gross pathologic image of the patient’s brain is shown below. What is the most likely etiology of the findings seen in this image?

Which of the following is NOT known to cause a drug-induced tremor?

A 42-year-old male presents as a trauma for a large motor vehicle accident. He is comatose, intubated but not sedated, and admitted to the trauma ICU. His brain imaging shows diffuse axonal damage. On examination, his pupils are reactive equally and corneal reflexes are intact, but otherwise, he has no motor response to pain, upgoing plantar reflexes bilaterally. The family asks if the patient is “brain dead”. Which of the following is not part of the confirmatory criteria on the standard brain death exam?