Quiz 06/25/2022 (2)

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?

Identify the structure (blue arrow) shown below:

Which is the following findings on EMG is suggestive of a chronic neurogenic lesion?

Which of the findings are most likely to be found on examination in a patient with the lesion appreciated in the image below?

A 27-year-old woman comes to the clinic for a routine checkup. She appears shy and does not make much eye contact. She mentions that she doesn’t have many friends because feels like she doesn’t deserve them and is fearful of rejection. She has had some depressive episodes in the past, but “does not want to bother anyone” about it. Which of the following is the most likely diagnosis?

A 32-year-old Chinese male is referred to the epilepsy clinic after experiencing two episodes concerning for possible seizures. The first episode was unwitnessed, but the patient states that there was an abrupt loss of consciousness and that he woke up with the side of his tongue bitten and generalized myalgias. The second event was witnessed by his wife who noticed one day that the patient was unresponsive and lip-smacking for 2 minutes before returning back to baseline. MRI brain was performed and showed left-sided mesial temporal sclerosis. Which of the following medications should be avoided for this patient?

A 59-year-old man with HTN, T2D, and peripheral vascular disease presents with sudden complete loss of vision in the left eye, which resolved after about 20 minutes. He denies any other symptoms. Which of the following vessels was most likely obstructed?

A 37-year-old man with a history of hypertension presents to the emergency department with a one-day history of difficulty walking. On examination, he has right leg paresis and hyperreflexia with a right-sided Babinski response. His non-contrast axial CT scan is shown below. Which of the following is the most likely etiology of this patient’s symptoms?

A 17-year-old female with a past medical history of anxiety, depression, and irritable bowel syndrome presents to the emergency room after a transient clinical episode. Her mother states that they were eating dinner when her daughter dropped to the floor and began having generalized shaking movements of her arms and her legs. She was unresponsive during the event and her eyes were closed. The event lasted approximately 30 seconds and there was no post-ictal confusion. In the emergency room, the patient has another event, where pelvic thrusting and asynchronous movements were appreciated for 2 minutes before resolution. The patient stated that she remembered having no control of her body during the event in question. Based on the most likely diagnosis, which of the following is the most appropriate treatment?

A 78-year-old male with no past medical history presents to the ED with left-sided hemiparesis and slurred speech at 9 AM. She is unable to provide a clear clinical history. She was noted to be found at 7:30 AM in bed with the above-stated symptoms. Her husband states that the patient went to bed at 10:00 PM the previous night without any symptoms. CT head shows no blood or hypodensities, and CTA head/neck reveals a right MCA occlusion. Her NIHSS is 17. Which of the following treatment options is the most appropriate next step based on the available data?

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?

Metachromatic leukodystrophy is due to a deficiency of which of the following enzymes?

This gross microscopic image is most consistent with which of the following diseases?

Which of the following identifies the sigmoid sinus?

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?

A blood clot in which artery explains the findings below?

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

Which of the following issues in early development has occurred in the photograph below?

A 34-year-old woman comes to the emergency room with complaints of neck stiffness, headaches that are worse on standing, and diplopia. An MRI brain with contrast shows diffuse dural enhancement. Which of the following findings is also likely to be present in this case?

A 79-year-old woman presented with the acute onset of difficulty walking and nausea that started about 24 hours before presentation. Examination revealed left-beating nystagmus and left-sided appendicular and truncal ataxia. Her axial FLAIR MRI imaging is shown below. The pathology shown is seen in which of the following vascular territories?

A 66-year-old patient with bradykinesia, hypomimia, dementia, postural instability, cogwheel rigidity, shuffling gait, and resting tremor presents to your clinic. He has been on carbidopa/levodopa for several years, which has helped, but now his wearing-off phenomenon is becoming more frequent despite attempted medication adjustments. He asks about deep brain stimulation (DBS).

Which of the following is a contraindication for DBS in Parkinson’s disease (PD)?

Which of the following medications has been shown to improve neurological outcomes in patients with subarachnoid hemorrhage?

A 68-year-old male with a 10-year history of Parkinson’s disease comes to the clinic for routine follow-up. He currently is taking levodopa/carbidopa, entacapone, and ropinirole. The patient is complaining of significant dyskinesias and unpredictable motor fluctuations between doses of levodopa/carbidopa. What is the most appropriate next best step in management?

An 18-year-old woman with a history of symptomatic epilepsy presents with medically-refractory seizures. An MRI brain is performed during presurgical evaluation and reveals the non-contrast-enhancing lesion shown below on T2 FLAIR. This lesion is most likely which of the following?