Quiz 06/09/2022 (3)

A patient with an AVM rupture is admitted to the ICU. On exam, the patient has abnormal neck, elbow, and knee extensor posturing, and wrist flexion. In which of the following locations was the AVM most likely located?

A 75-year-old man with hypertension and diabetes presents to the emergency department with a sudden onset of loss of sensation in the buttocks, perineum, and inner surfaces of both thighs, and urinary and fecal incontinence. On physical exam, he has loss of pain and light touch in the area described, as well as a loss of sphincter tone, and hyperreflexia in the lower extremities. Strength is mildly decreased in the distal lower extremities, without atrophy. What structure is most likely injured?

A 24-year-old female in her third trimester of pregnancy, with no other past medical history, presents with complaints of 1-2 times monthly episodes of sudden onset severe room spinning, nausea, and vomiting for 3 months. They happen randomly and are not associated with head movement. During an episode, sounds and bright light seem to bother her more. She denies motor weakness or hearing change. Her spells resolve after about 1 hour. She endorses she has had bad headaches in the past, but not with these episodes. She endorses she gets car sick easily. On neurologic examination, she has no focal findings, and her vitals are within normal limits. She had an MRI brain with MRA and MR Venogram, all of which were unremarkable. Which is the most likely etiology?

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?

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 20-year-old female presents with complaints of 2 years of excessive daytime sleepiness and brain fog during the day. She reports sleeping is unrefreshing. In the morning she has difficulty waking up and feels an uncontrollable desire to go back to sleep. She denies difficulty staying asleep during the night and denies episodes of suddenly collapsing in stressful situations. She had a polysomnogram where she slept for 12 hours, had 4 apneic episodes per hour, had REM sleep onset latency of 7 minutes, and did not have sleep-onset REM periods (SOREMPs). Which of the following is her diagnosis?

A 36-year-old female with bilateral lower extremity weakness, hyperreflexia, and difficulty emptying her bladder gets an urgent MRI with contrast of her thoracic spine (T2 sagittal (left) and axial (right)). Which of the following is the most likely diagnosis?

A chronic alcoholic is admitted to the hospital for altered mental status. An MRI is performed and shown below. What symptoms/signs are most likely seen on examination?

A 28-year-old male with a known history of neuromyelitis optica spectrum disorder (NMOSD) and a recent diagnosis of acute optic neuritis returns to the emergency room for worsening monocular vision loss despite completing 5 days of high dose (1 gm/day) methylprednisolone therapy. Based on the clinical scenario and level of evidence for efficacy, what is the most appropriate next step in therapy?

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?