Quiz 06/18/2022

Which of the following symptoms is atypical for essential tremor?

A 27-year-old woman presents with recurrent episodes of tinnitus, vertigo, and hearing loss. She denies any associated headaches. Episodes typically last between 2 and 6 hours in duration. MRI of the brain with and without contrast did not reveal any pathology. Physical examination is unremarkable except for sensorineural hearing loss appreciated in the right ear. Which of the following is the most likely diagnosis?

A 32-year-old female who is currently 39 weeks pregnant was brought to the emergency room after experiencing a first-time seizure. Neurological examination is non-focal except for mild somnolence and decreased visual acuity in both eyes. Vitals signs were normal except for a blood pressure of 192/104 mmHg. An MRI was performed and shown below. Which of the following is the most appropriate step in management?

A 62-year-old woman presents to your clinic with complaints of dizziness. She states that about 2 weeks ago she had some dental work done including a root canal, and ever since then has had spells of extreme dizziness. She describes that the room spins and she becomes sick to her stomach. The sensation is improved by sitting very still. It completely resolves in between episodes, and episodes happen about once or twice a day. She noticed that it happens consistently when she tries to back out of the driveway in the early morning. She had a CT head one day ago that was read as normal. On exam, she has inducible nystagmus. The otoscopic exam is normal. Which of the following is the most accurate statement?

A 7-month-old girl with a past medical history of hypotonia, weight loss, and failure to thrive is brought to the clinic by her parents. An MRI was performed and T2 sequence images from this study are shown below. What is the most likely diagnosis?

An overweight 54-year-old male presents to the neurology clinic with excessive daytime sleepiness. His wife states that the patient snores excessively during sleep. Which of the following is the most appropriate diagnostic test?

A 20-year-old male presents with severe burns on his hands after accidentally touching a stove. Neurology was consulted because the family noted that the patient did not initially pull away from the hot stove as one would expect. Physical exam shows decreased sensation of pain and temperature along the back and arms, with intact strength. T2 sagittal MRI of the cervical spine is shown below. Which of the following is commonly associated with the pathology shown?

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

A 12-year-old male is brought to the clinic accompanied by his father who states that for the past 4 months he has been randomly flailing his arm during class and calling out in the middle of the teacher’s lectures. He has been sent to the principal’s office twice in the past month for his disruptions. His father states that this is very out of character for him. In the clinic, the patient has intermittent movements of his right arm, where he raises his arm above his head and then slaps it down on his leg. Additionally, during the exam, he blurts out words that do not make contextual sense in the conversation. Two months later, the patient follows up with his father who states that all of the abnormal movements and vocalizations have resolved. What is the most likely diagnosis?

What is the pathophysiology that leads to the pathology shown in the image below?

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

A 37-year-old female with a past medical history of chronic fatigue and heat intolerance presents with right arm weakness. A cervical spine MRI is performed and shown below (Left: T2 sagittal. Right: T2 axial). Which of the following is the most likely diagnosis?

According to Practice Parameters by the American Academy of Neurology, Which of the following is not recognized as a reliable assistive device in accurately predicting a poor outcome in comatose patients after cardiopulmonary resuscitation for cardiac arrest?

Axial T2 (left) and T1 (right) brain MRI images of a 3-month-old with a history of seizures and developmental delay are displayed below. Which of the following is the most likely cause for the pathology shown?

A 66-year-old right-handed male presents to the EMG/NCS lab with right upper extremity pain, numbness, and weakness. Based on the data collected, what is the most likely diagnosis?

Which of the following is the mechanism of action of memantine?

A 26-year-old female presents with unilateral vision loss. She says that she noticed symptoms upon awakening yesterday morning and it has gotten progressively worse since then. On neurological examination, she has 20/70 visual acuity of the left eye and 20/20 of the right. There is a left afferent pupillary defect (APD). Extraocular movements are intact but cause pain. What is the most likely etiology of her symptoms?

A 30-year-old woman presents to the clinic with severe headaches requesting treatment because she “can’t live with this pain”. Episodes are left-sided, occur multiple times a day, and last about 20 minutes each. During episodes, she will also have eye tearing and rhinorrhea. What is the appropriate therapy?

A 24-year-old patient had a severe unhelmeted motorcycle accident and despite best efforts by medication providers, he passed away two days later. An autopsy was performed. Identify the structure marked by the white arrow.

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?

A 38-year-old man with a past medical history of HIV, depression, and asthma presents after experiencing a first-time seizure. He was last seen normal about 45 minutes ago by his husband, who witnessed him seizing for about 10 minutes. A CTH is performed and normal. A lumbar puncture is performed and reveals the findings below. Which of the following is the most likely cause of the patient’s symptoms?

This muscle biopsy is most consistent with which myopathic disease? 

A 16-year-old girl with no significant past medical history presents to the clinic with 2 episodes of syncope in the past month. She states that both of the episodes occurred while giving oral presentations in front of her class. She reports that she has been under a lot of stress lately because of a midterm paper and that her parents are going through a divorce, which has taken an emotional toll on her. Before each episode of syncope, she feels warm and starts to get lightheaded, and “sees stars”. Each episode of syncope lasts approximately 15 seconds, and she does not have any confusion after the episodes. The physical exam is within normal limits. Which of the following is the most likely cause of this patient’s syncope?

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