Quiz 06/16/2022

You are asked to see a 64-year-old man with hypertension, hyperlipidemia, and peripheral vascular disease who is post-operative day 1 from an aortic aneurysm repair. On exam, he exhibits bilateral lower extremity weakness, as well as loss of pain and temperature sensation below the umbilicus. Light touch and proprioception are intact in the lower extremities. What is the most likely diagnosis?

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?

Vasogenic edema would be best appreciated on which of the following MRI sequences?

Initiation of urination involves which of the following physiologic processes?

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?

A 25-year-old female with no significant past medical history presents with a two-day history of progressive bilateral lower extremity weakness and numbness. On physical exam, she has 3/5 strength in hip flexion and knee extension bilaterally, along with a loss of sensation. She is up to date on all vaccinations. She is afebrile. Sagittal (left) and axial (right) T2 thoracic MRI images are shown below. Which of the following is the most likely diagnosis?

Which of the following vessels drains into the sigmoid sinus?

A 57-year-old male with HIV who is non-compliant with HAART therapy presented to the emergency room with a 4-week history of altered mental status and falls. On neurological examination, the patient was altered, ataxic, and had right upper extremity weakness. An MRI was performed and shown below. Based on the clinical presentation and imaging provided, what is the most appropriate first step in medical management?

A study published in 1992 indiscriminately assigned 457 patients with optic neuritis to receive either 14 days of oral prednisone, 3 days of intravenous methylprednisolone followed by 11 days of prednisone, or an oral placebo for 14 days as an acute therapy. Visual function testing was performed intermittently over a six-month follow-up period. The results showed that patients who received methylprednisolone followed by oral prednisone had a faster rate of visual recovery. What type of study design was this?

An 83-year-old man presented with an acute onset of difficulty walking and nausea about 12 hours prior to being seen in the emergency room. Examination revealed vertigo and truncal ataxia. An MRI was performed to evaluate for stroke. The FLAIR axial MR image is shown below. What is the vascular territory damaged in the imaging provided?

A patient with medically-refractory epilepsy has an MRI brain performed as part of their pre-surgical workup. Based on the imaging provided, what type of seizures is this patient most likely experiencing?

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 36-year-old woman presents with facial weakness. She states that symptoms started on the right side of the face one week ago, but since then the left side has also become progressively weak. Other pertinent complaints include dry cough, shortness of breath, and joint pain. MRI of the brain shows bilateral contrast enhancement of the facial nerves. Chest X-ray reveals bilateral hilar adenopathy. A diagnostic lymph node biopsy is performed. Which of the following is most likely appreciated on pathologic analysis?

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?