Quiz 06/21/2022

An 8-year-old girl presents with a progressive neurologic disorder. She initially was noted to have slow learning and clumsiness years ago. Shortly thereafter she developed a seizure disorder of unclear etiology. Now, she has been having progressive visual changes and worsened cognition and memory. To aid in the diagnosis, a muscle biopsy is done and shows autofluorescent curvilinear bodies. Her disorder falls into which category of disease?

A 45-year-old female with a past medical history significant for asthma presents to the clinic for migraines with aura. Her headaches occur at least 13 times a month. She was given sumatriptan for abortive therapy six months ago but it has become ineffective. Her vital signs are stable. Her BMI is 33. Which of the following is the best next step in treatment?

Which of the following features on EMG is suggestive of chronic denervation?

A 66-year-old female comes to the EMG lab with the chief complaint of muscle cramps in the right lower extremity. She started having symptoms after treatment with a cholesterol-lowering medication but despite discontinuing the medication her symptoms persisted. Reflexes are 2+ in upper and lower extremities, except 1+ in the right Achilles. Nerve conduction studies of both lower extremities were normal. An EMG was performed and shown below. What is the most likely diagnosis?

Which of the following is the correct order of internal carotid artery segments (from proximal to distal)?

Which of the following medications increase the risk of contraceptive failure in patients taking estrogen-containing oral contraceptive pills (OCPs)?

A 5-month-old female is brought to the emergency room by her parents because of an episode concerning for possible seizure. On arrival, the patient appears back to her clinical baseline neurologically. Several hypomelanotic lesions are appreciated while performing a skin check. The mother notes that her older brother has similar skin findings. An EEG is performed and shown below. A typical event was captured that correlated with an electrodecrement of cortical activity on EEG.

Based on the child’s diagnosis, what is the most appropriate therapy?

Which of the following is not a risk factor for the development of natalizumab-associated PML?

A 67-year-old male presents with the inability to reach for objects in his visual field. He states that he can see the object, but on the clinical exam he can not grasp it accurately. He also is unable to see multiple objects at once. He has a past medical history of atrial fibrillation and an ischemic injury is suspected. A brain MRI would show which of the following areas of the brain is/are affected?

A newborn male is evaluated in the NICU for a lesion on his lower back. He was born to a mother with no prenatal care at 37 weeks gestation. Imaging of his lower back shows the meninges and spinal cord herniated through the defect, covered in a membrane. His condition could have most likely been prevented through prenatal supplemental with what?

A patient with a past medical history of Parkinson’s disease is brought to the emergency room with the chief complaint of a severe headache, chest pain, and shortness of breath. His blood pressure on arrival was 196/122 mmHg. The patient states that he was in his usual state of health earlier in the day but started feeling unwell after attending a wine and cheese pairing event at a local winery. Which of the following medications is likely the cause of the patient’s symptoms?

A 32-year-old man with a past medical history of major depressive disorder is brought to the emergency department by his roommate who states that a few days ago the patient stopped taking his medications. Vital signs were within normal limits. On examination, the patient was non-verbal except for occasionally repeating words spoken by the examiner. He would not follow commands. When his arms were positioned off the bed they remained there for several minutes. CT head and CTA of the head and neck were normal. Which of the following is the most appropriate next step in treatment?

A 65-year-old woman with a past medical history of hypertension presents with recent onset of bilateral eye discomfort and diplopia. She states that she is unable to completely close her eyes. On exam, pain is elicited when testing extraocular movements. Visual acuity and visual fields are unremarkable. MRI of the brain reveals excessive peri-orbital subcutaneous tissue bilaterally. Which of the following is the most likely diagnosis?

All of the following therapies can be useful in the management of cluster headaches except:

A 72-year-old female presents to the clinic with her husband who states that she is “seeing things that aren’t there”. For the past two weeks, she has been complaining of bats flying around her room at night. Comparable visual disturbances have occurred over the past year, but have gotten progressively worse recently. She has also been acting out a lot at night; her husband states that she has been violently kicking and flailing her arms while asleep. Finally, she has been experiencing cognitive decline, including forgetting where she lives, what year it is, and the names of her grandchildren. On exam, there is symmetric cog-wheel rigidity appreciated. What is the most likely diagnosis?