Quiz 06/21/2022 (2)

A 78-year-old patient with a history of multiple system atrophy (MSA) presents to your clinic for falls. The patient states that while standing he initially experiences feelings of lightheadedness and tunnel vision before a loss of consciousness. While on the ground he will be “twitching” for 30 seconds before he regains consciousness. Which of the following tests is the most likely to be diagnostic in this case?

An 18-year-old male is brought to the clinic by his mother due to a 3-month history of personality changes. She states that during this time he has become increasingly rude and aggressive toward her. She also states that he was fired from his summer job last week after trying to steal from his boss. His father’s medical history is unknown. On examination, the patient has an ataxic gait and bradykinesia. His mental status exam shows impaired memory and language regression. Genetic testing of this patient would most likely show what?

Mutations in the progranulin protein (gene PGRN) can serve as a biomarker for the risk of which of the following diseases?

A patient with a history of focal to bilateral tonic-clonic seizures has an EEG performed to see if they have responded to levetiracetam. Based on the EEG below, from which region of the brain does epileptiform activity arise?

Congenital muscular dystrophies are most often associated with which of the following pathophysiologies?

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

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 identifies the straight sinus?

A 57-year-old male undergoes a cervical decompression laminoplasty for myelopathy, and on postoperative day #2, he complains of severe left shoulder pain. On examination, he has weakness with abduction of the left arm at the shoulder and flexion of the left arm at the elbow. This patient’s lesion localizes to which nerve root?

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 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 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?

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

Which of the following is the most appropriate initial screening test for suspected restless leg syndrome?

A 42-year-old man with a longstanding history of chronic alcohol abuse was found down unresponsive in a public park. He was intubated in the field and brought emergently to the emergency room where his blood alcohol level was 0.32%. A chest X-ray revealed aspiration pneumonia. He was admitted to the ICU, sedated, started on broad-spectrum antibiotics, and aggressively fluid resuscitated. On the second day of the hospitalization, the sedative was weaned but the patient remained comatose. An MRI was performed to identify a possible cause of his symptoms. What is the most likely diagnosis?