Quiz 06/10/2022

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 50-year-old male presents to the emergency room with a three-day history of double vision and difficulty walking. Neurological examination reveals decreased eye movements. Strength in the limbs is relatively preserved but all reflexes are absent. There is also marked limb clumsiness. Which of the following is the most likely diagnosis?

The pathology shown in the image below is most likely which of the following?

A 69-year-old male presents to the clinic with his wife who states that for the past 10 months the patient has become increasingly slow and more clumsy with daily activities. He has also been complaining of dizziness, especially in the morning when he first gets out of bed and has fallen once in the past month. On physical exam, it is observed that the patient has a 21 mmHg drop in systolic blood pressure when going from a sitting to a standing position. A brain MRI is ordered and shows a cruciform hypointensity in the pons. What is the most likely diagnosis?

A 26-year-old woman presents to the emergency department with third-degree burns covering the entire palmar aspect of her right hand. She claims that she was cooking dinner and touched the stove, but states that she “didn’t notice it was hot”. On neurologic exam, she is unable to distinguish between hot and cold sensations on her hands, arms, shoulders, chest, and back. She also fails to respond to pinprick sensation in the same distribution. She denies any major recent traumatic injuries. Which of the following is the most likely cause of her symptoms?

A 38-year-old woman with a history of gastric bypass begins taking over-the-counter supplements that are intended to promote hair and nail health. After several months, she begins to experience paresthesias in her legs and has several falls. She is referred to a neurologist. On examination, she is noted to have non-length-dependent severe loss of vibration sensation in her legs, loss of pain and temperature distally in a length-dependent pattern, and spastic tone with hyperreflexia in her lower extremities. Additionally, her gait is wide-based and a Romberg’s sign is positive. Which of the following treatments is most likely to prevent further neurologic deterioration?

A 45-year-old man with a past medical history of IV drug use presents with a 3-day history of back pain and fever with numbness and tingling in his arms bilaterally. He is now unable to write his name or button his shirt. His cervical MRI is shown below. Which of the following is the most likely diagnosis?

A 65-year-old right-handed man presents with an acute onset of aphasia. CT scan of the head was normal but the MRI revealed multifocal small acute and subacute ischemic strokes in multiple vascular territories. A cerebral angiogram was performed as part of the diagnostic workup. Based on the clinical history and imaging provided what is the most likely diagnosis?

A 32-year-old man was recently admitted to the stroke service for an intracranial hemorrhage secondary to an arteriovenous malformation. In addition to his acute focal neurological deficits, the following skin lesions are appreciated (see image below). A genetic syndrome is suspected. Based on the most likely clinical diagnosis, what is the risk of his son having the same condition?

Which of the following is appreciated in the right posterior quadrant in the EEG shown below?

A 57-year-old man with a past medical history of bipolar disorder, atrial fibrillation, and type 2 diabetes presents to the clinic with complaints of a tremor. Symptoms have been present for years but they have not seemed to progress significantly over time. His current medications are warfarin, metformin, low-dose aspirin, and lithium. His neurological examination was unremarkable except for the presence of a fine, high-frequency tremor in his bilateral upper extremities. Based on the most likely diagnosis, what is the most appropriate next step in medical management?

A 30-year-old female presents to the ER with a three-day history of progressive weakness, double vision, and slurred speech. The first symptoms appreciated were double vision and slurred speech, followed by weakness in the upper extremities. Symptoms then descended to involve the lower extremities. On examination, the patient had decreased tone, areflexia, mydriasis, and restricted extraocular movements bilaterally. A neuromuscular junction disorder is suspected. Based on the most likely diagnosis, which of the following would be seen in this patient’s neurodiagnostic testing?

You have recently diagnosed an asymptomatic 45-year-old man with Huntington’s disease based on genetic testing which was requested based on a family history of the disease. The patient was informed of these findings in the clinic with his wife by his side. On the following day, you receive a phone call from the patient’s 23-year-old son asking what the results of the testing were. What is the most appropriate response to this question?

Which of the following arteries provides the prominent supply to the posterior limb of the internal capsule?

An 11-month-old male is brought to the emergency room with agitation, fever, and nuchal rigidity. A review of the patient’s electronic medical record shows that the patient was admitted with meningitis 2 months ago. While no clear focal neurological symptoms were appreciated on examination, there was a midline dimple appreciated in the lumbosacral region. Which of the following is the most likely etiology of the patient’s recurrent illness?