Quiz 06/14/2022

A 40-year-old male presents with a one-day history of numbness of his right arm. This has never happened before, but he does report an episode of left leg weakness that self-resolved two years ago. The neurological examination confirms a sensory disturbance of his right arm. Sagittal MRI of the cervical spine is shown below (Left: T1, Middle: T1 with contrast, Right: T2). Which of the following is the most likely diagnosis?

A 34-year-old female with a history of chronic daily headaches had an MRI performed as part of her workup. Her imaging is shown below. What is the likely etiology of the lesion shown?

You are asked to see a 2-month-old infant girl with hypotonia, macroglossia, failure to thrive, and cardiomyopathy. Muscle biopsy is done due to the hypotonia, and shows PAS+ vacuolar myopathy. What is the best treatment approach?

Which of the following is most commonly associated with NMDA-receptor encephalitis?

A 65-year-old female comes to the clinic complaining of weakness in his extremities. Symptoms are more prominent in the legs than in the arms. Oddly, when he tries to exert himself, he notes an improvement in his strength. Neurodiagnostic testing reveals low amplitude compound muscle action potentials (CMAPs) with an increase in amplitude on high frequency (50 Hz) rapid repetitive stimulation. Which of the following malignancies is most closely associated with this patient’s neurologic syndrome?

An 11-year-old female presents with worsening stiffness. She had no complications while in utero or at birth, yet ever since she started kindergarten she noted to have stiffness in her feet and ankles, which worsens by the end of the day. She eventually started to notice modest stiffness in the legs and mild stiffness in the neck. She underwent physical therapy for this and remained stable. Over the last 2 years, however, the symptoms have been worsening. Which of the following next steps is most indicated?

You are caring for a 1-month-old infant in the neonatal ICU with abnormal movements since birth. The baby is seen writhing in bed, with her arms and legs and axial trunk moving in a snake-like pattern. A CT head is done and shows bilateral cystic lesions on the basal ganglia. Toxic levels of which of the following are most likely at play?

A 45-year-old female presents to the emergency room after experiencing a first-time seizure. On examination, she has some mild RUE weakness and anomia. MRI w/o contrast was performed and shown below. Which of the following is the likely cause of her lesion?

A 12-year-old boy with no significant past medical history is admitted to the neurology service after presenting with acute-onset fever, personality changes, and difficulties with speech. His mother states that three days ago he also reported seeing bats and other wild animals running around his room. She decided to bring him to the hospital today after she noticed that he seemed more tired and was moving slower than normal. A lumbar puncture and MRI of the brain are ordered. The CSF shows elevated protein, elevated lymphocyte and red blood cell counts, and normal glucose. MRI of the brain is shown below. What is the most likely diagnosis?

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?

An 11-year-old girl has a neurosurgical resection of a brain mass. You are consulted post-op day 2 due to speech decline progressing to complete mutism. She does not have any weakness on exam. What type of tumor was most likely resected?

A 37-year-old female with a PMH of Sjogren’s, and a recent motor vehicle accident (MVA) is referred to the EMG Lab for evaluation of right arm pain/weakness. The patient endorses right head pain which radiates down her neck into the right shoulder and wrist. Examination shows 5/5 strength in the upper extremities except for 4+/5 deltoid and 4+/5 biceps strength in the right upper extremity. Sensation to light touch was intact throughout. Sensory nerve conduction studies of the right upper extremity were normal. Based on the patient’s EMG results outlined below what is the most likely diagnosis?

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 10-year-old female from the northeastern United Stated presents to the ED with her mother after a one-week history of difficulties in school and difficulties with speech. Her mother states that two weeks ago the patient had a rash on her leg and viral-like symptoms that went away within a few days. Then, this past week the patient’s teacher reported that she was having difficulties with attention in school and was performing very poorly on assignments. Her mother also confirmed that the patient has been more forgetful and is also slurring her speech. An MRI of the brain was performed and it showed multifocal white matter lesions. Of note, the patient likes to spend a lot of time outdoors and recently went on a camping trip. Which of the following is the most likely cause of the patient’s symptoms?

Which of the following EEG patterns is typically seen over the age of 50?

Lesion to which area of the brain causes impairment in naming, fluency, and repetition with intact comprehension?

A 78-year-old woman is brought to the neurology clinic by her husband for memory loss. Her husband states for the past 6 months he has noticed a progressive decline in her memory, particularly with recent events. She has also lost her keys and cell phone on numerous occasions around the house. Her MOCA score in the clinic was 25/30, with points lost for poor delayed recall and attention. Neurodegenerative disease is suspected. Which of the following medications is the most appropriate for this patient to help with her cognition?

Which of the following is the most classic finding of early inclusion body myositis?

Which of the following is most consistent with this EEG tracing?