Quiz 06/16/2022

A critically ill 1-month-old has cerebral vessel imaging performed and shown below. Which of the following comorbid medical issues are likely present?

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 20-month-old female presents for regression of milestones. She was walking, and now crawls or refuses to move. The parents are concerned she may be having seizures because they notice she has intermittent jerks of the limbs and trunk, especially when she is startled. on physical exam, you note conjugate random darting of the eyes in vertical and horizontal directions. Tone, strength, and deep tendon reflexes are normal.

What test is most likely to identify the underlying etiology of this problem?

Which of the following is the first branch of the internal carotid artery once it enters the skull?

A 23-year-old female with a past medical history of depression presents with right arm paralysis that started after she found out her boyfriend died from a motor vehicle accident. Her physical exam shows no effort during muscle strength testing and positive withdrawal when a noxious stimulus is applied. The rest of the neurological examination, including reflexes, was normal. MRI of the brain and cervical spine were unremarkable. Which of the following is the most likely diagnosis?

The following gross pathologic coronal section is presented to you for evaluation. The area shown by the black arrow is a sign indicative of which of the following disorders?

What is the anatomical structure marked by the blue arrow?

A 5-year-old female was brought to the neurology clinic for a second opinion for paroxysmal spells of dizziness. The family states that several times a month the patient will develop severe dizziness, nausea, and vomiting. Symptoms usually only last less than 5 minutes. An MRI and 24-hour ambulatory EEG have been performed in the last 3 months. Both were unremarkable. What is the most likely diagnosis?

A 33-year-old female presents to the clinic for evaluation of a left lower extremity foot drop. On physical examination, there is weakness in dorsiflexion. Ankle eversion, inversion, and plantar flexion strength are normal. Hip abduction strength is normal as well. Which of the following is the most likely etiology for the patient’s symptoms?

A 65-year-old man presents to the emergency room with progressive weakness over the course of several months. Examination shows pure motor weakness with no sensory involvement, decreased reflexes, and diffuse fasciculations. An EMG shows a conduction block of motor neurons outside of compression sites and normal sensory conduction velocities. Which of the following of most appropriate for treatment?

A two-month-old boy is brought to the Emergency Room by his mother because of lethargy for the past 3 hours. His mother states that earlier today the child rolled off the couch and hit his head on the hardwood floor. Physical exam shows excessive somnolence, tense anterior fontanelle, and fundoscopic exam shows bilateral retinal hemorrhages. A non-contrast CT of the head shows subdural hematomas of varying ages. A CT head is ordered and pending. Otherwise, what is the next most appropriate step in the management of this patient?

A 30-year-old woman with well-controlled epilepsy with lamotrigine monotherapy comes to the clinic today stating that she and her husband are planning to start a family. Which of the following statements is most correct regarding her clinical situation?

This muscle biopsy is most consistent with which myopathic disease?

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?

What is the pathophysiology that leads to the pathology shown with a black arrow in the image below?

A 32-year-old female with a history of schizophrenia is brought to the emergency room by her husband for acute psychosis. She receives a medication while in the emergency room to aid in her agitation. Soon after administration, the patient develops involuntary contractions of muscles of her face and neck. Which of the following medications was most likely administered to cause these symptoms?

What is the mechanism of action of phenobarbital?

A 47-year-old woman from the Caribbean presents to the clinic with a seven-year history of progressive difficulty with ambulation. The exam is notable for lower extremity spasticity. An MRI is ordered and shows atrophy of the spinal cord without other changes. The clinical and MRI findings for this patient are most likely secondary to which of the following infections?

A 62-year-old man complains of 5 years of vivid dreams. At times this involves punching and kicking, which has hurt his wife. He undergoes a polysomnogram and there is no sleep-disordered breathing and the EEG is normal. What would be the best first-line medication to treat this behavior?

A 67-year-old man with a past medical history of obstructive sleep apnea is being evaluated for bilateral arm tremors. His symptoms started insidiously 5 years ago. It is best appreciated when the patient brushes his teeth or eats with a fork. Oddly, he has noticed that a glass of wine at night can help with his symptoms. What is the most appropriate therapy for his movement disorder?