Quiz 06/10/2022 (2)

A 20-year-old man with a history of poorly controlled schizophrenia was admitted to the hospital by his parents for severe bizarre hallucinations. He informed the nursing staff that there were toxins in his body that needed to be flushed out and continuously asked for water. There was a concern for psychogenic polydipsia. Over the next two days, the patient was started on haloperidol, a fluid-restricted diet, and normal saline infusions. On the second day of hospitalization, the patient developed progressive confusion and gait instability. A brain MRI was performed and is shown below. Which of the following is the most likely etiology of his symptoms?

A 49-year-old woman with recurrent episodes of vertigo and has an MRI brain performed at the request of her neurologist. Imaging reveals a well-circumscribed dural-based homogenous contrast-enhancing lesion. What is the most likely etiology of the lesion outlined above?

A lesion to which of the following arteries could produce the ischemic findings shown in the MRI below (Brain MRI, axial cuts. Left: DWI sequence. Right: ADC sequence).

A three-month-old female born full-term and without any significant past medical history is brought to the clinic with episodes of head-nodding for the past one week. Episodes last for only a few seconds and only occur while awake. On physical exam, there is an abnormal head tilt to the left and intermittent head nodding. Intermittent, horizontal, and bilateral nystagmus was also appreciated. Routine EEG and MRI of the brain with and without contrast were normal. Which of the following is the most likely diagnosis?

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?

A 28-year-old woman of Chinese descent was recently diagnosed with focal/symptomatic epilepsy. Which of the following medications should best be avoided in the management of her epilepsy?

A 30-year-old female with no known past medical history comes to the emergency room after a generalized tonic-clonic seizure. Her friend says that she has been behaving oddly over the past couple of days and has been complaining of a headache. An axial T2 brain MRI is shown below. Which of the following is the most likely diagnosis?

A patient with Alzheimer’s disease donates their brain for research on neurodegenerative disease. A histopathologic, H&E-stained, sample of his brain tissue is shown below. What is the structure marked by the black arrow?

You are interested in initiating tetrabenazine for a patient with refractory chorea. You should educate the patient that this medication carries a black box warning for which of the following?

An 83-year-old male with a past medical history of PD is brought to the clinic with his daughter due to worsening behavior at his nursing home. He has become easily agitated with staff and will occasionally yell out at night at “people trying to rob him”. His daughter asks which treatments could be used to help with these symptoms. Which of the following antipsychotic agents would be the best treatment options?

Which of the following symptoms is unlikely to be caused by a lesion in the cavernous sinus?

A 65-year-old female with 40 pack-year history presents with a 2-week history of generalized weakness that improves with repeated testing. You are concerned for Lambert-Eaton myasthenic syndrome (LEMS). Which of the following statements is incorrect regarding LEMS and/or myasthenia gravis (MG)?

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

A 38-year-old man presents with a 1-year history of neck pain and left upper extremity weakness. The symptoms started insidiously, and have slowly worsened over time. A sagittal cervical spine MRI is shown below (Left: T2 without contrast. Right: T1 with contrast). Which of the following is the most likely cause of his symptoms?

A 68-year-old woman with no significant medical history presents in the emergency room with acute aphasia and right-sided weakness. Her wife who is in the room states the patient was last seen well one hour prior to arrival at the hospital. A CT scan of the head showed no acute hemorrhage. After screening the patient and discussing the risks and benefits of acute pharmacological therapy with her significant other the patient was given intravenous tPA. Thirty minutes later the patient had an acute neurological decline. She was sent for a repeat CT scan which showed a new 16 cc intraparenchymal hemorrhage in the left hemisphere. What is this an example of?

Which of the following comorbidities are responsible for the lesion appreciated in the image below?

A 6-month-old previously healthy male is seen in your clinic due to feeding difficulties and weakness for the past 8 days. The mother reports that he has also not had a bowel movement in 3 days. On physical exam, the patient demonstrates a weak cry, severe hypotonia, and hypo-responsiveness. No one else in the family is sick, however, they have been eating homemade molasses for the past 4 weeks. This patient’s condition is caused by a toxin affecting which structure?

An 8-year-old girl presents to the emergency room with a one-week history of progressive ataxia and headache. An MRI was performed and shown below. A biopsy was performed and Homer-Wright rosettes were found. What is the most appropriate treatment for this lesion?

Which of the following would not constitute or be concerning for a HIPAA violation?

A 38-year-old man presents to the emergency room with a 2-month history of headaches, increased thirst, and decreased libido. CT scan of the head shows a suprasellar, partially calcified mass. An MRI was ordered thereafter and is shown below. What is the most likely diagnosis?

A 62-year-old woman with low back pain presents to the emergency department complaining of 4 weeks of a strange sensation when wiping with toilet paper, as well as urinary and fecal incontinence. On exam, she has 5/5 strength throughout her limbs and normal deep tendon reflexes. What is the location of her lesion?

A previously healthy two-year-old girl is brought to the clinic by her parents due to a 1-month history of difficulty walking. Her parents state that she began walking at 11 months old, but over the past month she has been falling more often. On physical exam, the patient demonstrates a broad-based gait and truncal ataxia. A CT scan of the brain is ordered and shows an intraparenchymal hyperdense mass in the cerebellum. She undergoes resection of the mass and a pathologic examination of the specimen shows anaplastic small round blue cells. What is the most likely diagnosis?

A 74-year-old male with a past medical history of hypertension and hyperlipidemia is brought to the physician by his daughter who states that he has been exhibiting abnormal shaking of his hands and difficulty walking for the past year. On exam, the patient exhibits a shuffling gait, a tremor of his left hand at rest, and difficulty initiating movements. Which of the following is the most appropriate first-line therapy?

Which of the following is a common side effect of levodopa therapy?