Quiz 06/22/2022 (1)

Which of the following regions of the brain, when active, promotes the switch from drowsiness to non-REM sleep?

A 40-year-old man from Honduras presents to the emergency room after experiencing a first-time seizure. CT head showed multiple calcified intraparenchymal lesions. Physical examination in the emergency room was unremarkable except for the presence of multiple subcutaneous nodules. A biopsy of one of these nodules was completed and microscopic imaging of the lesion is shown below. What is the most likely diagnosis?

Chronic exposure to which of the following medications can cause the pathology appreciated on the pathology slide below?

A 31-year-old female with depression, anxiety, and migraines presents to the ED for altered mentation. On arrival, she has a temperature of 41 degrees Celcius, HR 130, and a systolic blood pressure of 190. On exam, she is diaphoretic and agitated, with increased tone, hyperreflexia, shivering, and dilated pupils.

You call her family who states that the patient has a hard time keeping down a job, frequently moving from state to state. She has had a number of different psychiatrists over the years, and you, therefore, are unable to find a comprehensive medication list. In her purse, she has a pill bottle of sertraline, with 85/90 pills remaining.

Which of the following other medications is this patient likely taking?

A 34-year-old male presents with personality changes that started after a motor vehicle accident-related traumatic brain injury. His family has noticed that since the accident, the patient no longer actively seeks out hobbies that he once enjoyed. He will often forget to eat meals unless prompted, even if the food is placed in front of him. Which of the following medications would most likely help with his behavior?

Which of the following statements is correct regarding F-waves?

A neurology consult is placed on a full-term newborn male after being delivered by an uncomplicated vaginal delivery with good APGAR scores. The physical exam reveals a midline lesion in his lumbar region. Based on the pathology shown below, which of the following would most likely also be present on head imaging?

A 6-year-old male with a history of medically-refractory epilepsy (on three anti-seizure medications), and right-sided-hemiparesis, presents to the emergency room with a three-day history of continuous right facial twitching. Symptoms persist during sleep and have not responded to benzodiazepines. On examination, the patient has retained awareness despite the continuous facial movements. MRI brain was performed and shown below. Of the following, which is the most appropriate therapy to achieve seizure freedom?

A 4-day-old full-term baby is brought to the hospital for two episodes of generalized stiffening and apnea for less than 1 minute followed by a return to baseline. The physical exam is unremarkable and CTH is negative. The mother reports having similar episodes shortly after birth. What is the most likely cause of the episodes?

Aquaporin-4 (AQP4) channels are found on which cell type?

What is the state of the patient in the EEG shown below?

A 58-year-old male presents with a few months of progressive symptoms. He reports limb rigidity, left greater than right, as well as neck stiffness. On exam, you note bradykinesia and cervical dystonia. He does not have a tremor. Speech is hesitant, and there is evidence of speech apraxia. You also note that the patient has trouble controlling the location of his left hand in space, and he grabs for your stethoscope without realizing it.

What is the most likely diagnosis?

A 19-year-old woman was brought to the emergency department after a rollover motor vehicle accident. On arrival, she was intubated and sedated for respiratory failure secondary to pneumothorax. Examination revealed intact brain stem reflexes and decreased spontaneous movement of the left side of her body. Her axial head CT scan is shown below. What is the most likely diagnosis?

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

A 64-year-old man with idiopathic Parkinson’s disease being treated with carbidopa-levodopa is experiencing significant wearing-off despite increasing frequency and dose of levodopa-carbidopa, which is now producing significant peak dose dyskinesia. Which of the following would be a reasonable next agent to prescribe to reduce this wearing-off effect?

Which of the following can be appreciated on the T1 MRI sequence shown below?

A 35-year-old man developed a right clavicle fracture after an accidental fall from a ladder while hanging Christmas lights. He was treated conservatively with a figure-of-eight bandage and sling. He presents to your clinic 2 weeks after the accident. He states ever since the accident he has had right arm and shoulder pain, as well as numbness extending from his triceps to his middle dorsal aspect of the forearm, wrist, and dorsal aspect of digits 1,2 and 3. On examination, his strength is 5/5 throughout all extremities except 4/5 to abduction of the deltoid, extension of the triceps, and wrist extension.

Which nerve or cord, if injured by the clavicle fracture, would explain his symptoms?

The epileptologist’s EEG report for a patient in the neuro-ICU identifies a “burst suppression” pattern. Which of the following is not a criterion required to diagnose burst suppression?

The medulla develops from which of the five primary vesicles of the brain?

An 11-year-old female presents with worsening stiffness. She had no complications while in utero or at birth, yet ever since she started kindergarten she noted to have stiffness in her feet and ankles, which worsens by the end of the day. She eventually started to notice modest stiffness in the legs and mild stiffness in the neck. She underwent physical therapy for this and remained stable. Over the last 2 years, however, the symptoms have been worsening. Which of the following next steps is most indicated?