Quiz 06/25/2022

A 42-year-old woman with multiple sclerosis presents to the ER after having worsening confusion over a few days with worsening weakness and vision loss. She was on natalizumab for years and her most recent JCV antibody titer was negative. She has missed several months of infusions due to her helping a sick relative. Her MRI shows multiple new T2 hyperintensities with enhancement in the periventricular and subcortical white matter. What is the most likely diagnosis?

You are caring for a patient with Lewy body dementia who is having difficulty with myoclonic jerks. Which of the following is considered the first-line treatment for cortical myoclonus?

A 38-year-old man with a past medical history of chronic cough, and shortness of breath presents with a three-week history of recurrent headaches, confusion, and difficulty with speech. On exam, there are difficulties with attention and mild aphasia. Additionally, there appear to be erythematous nodules along his shins bilaterally. Brain MRI shows a contrast-enhancing lesion in the left hemisphere. Due to the patient’s chronic pulmonary complaints, a chest X-ray is also performed. Which of the following is most likely seen on a chest X-ray?

A 20-year-old female presents to the clinic with weakness and numbness in the right leg. She states that earlier in the day she was taking a long nap on her right side, and when she awoke, her entire leg felt like pins and needles. When she got up, she felt that she was dragging her right leg on the floor. She has had similar experiences in other limbs over the years but symptoms would slowly improve over weeks. Nerve conduction studies showed a right common peroneal nerve conduction block and mildly decreased conduction velocities of all nerves tested. Her mother reports that her father had similar episodes before he passed away from an unrelated illness. Which of the following is the most likely diagnosis?

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

A 46-year-old female presents to the clinic with right-hand numbness, specifically in the 4th and 5th digits. EMG testing reveals fibrillations on the first dorsal interosseous, and flexor pollicis longus. EMG testing of the abductor pollicis brevis and triceps was unremarkable. These findings are most likely caused by radiculopathy of which of the following nerve roots?

Which of the following symptoms can be seen with MCA-PCA watershed infarcts?

A 61-year-old male with hypertension, hyperlipidemia, diabetes, and coronary artery disease presents after a sudden onset of headache and difficulty speaking, with left arm and leg weakness. Their blood pressure is 212/105 mmHg, and their blood glucose is 275 mg/dL. You notice aspirin on his medication list. A CTH is performed and is notable for a 25 cc hemorrhage in the right basal ganglia. Which of the following is correct?

Which of the following symptoms seen with normal pressure hydrocephalus (NPH) is the most responsive CSF shunt placement?

Nursing staff in the neonatal intensive care unit noticed that a 32-week gestational age newborn with a complicated delivery and low initial Apgar scores and intracranial hemorrhage developed abnormal movements on the 2nd day of life. The movements were described as rhythmic, high-frequency movements of the left limb. There were no associated autonomic changes appreciated with events. The child was placed on continuous EEG recording and an event was captured which had no EEG correlate. What is the most likely diagnosis?

A 40-year-old male with bilateral mesial sclerosis and medically refractory epilepsy presents to the epilepsy monitoring unit for a presurgical evaluation. His current anti-seizure medication regimen includes levetiracetam, lamotrigine, and clobazam. Over three days and weaned medication, the patient had 7 seizures; four from the left temporal lobe, and three from the right temporal lobe. Which of the following is the most appropriate next step in treatment?

A 27-year-old man presents after having an unprovoked generalized tonic-clonic seizure. Which of the following should he be told regarding his clinical situation?

A 65-year-old female presents to the Emergency Room with a 2-month history of altered mental status and jerking. On examination, you appreciate an exaggerated startle response. Her MRI was shown below. Which of the following statements is true?

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

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

A 45-year-old female presents as a trauma for an unhelmeted motorcycle accident. She has sustained significant blunt head trauma, and CTH shows hydrocephalus caused by edematous mass effect compressing the fourth ventricle. Which of the following shows the correct directional flow of CSF in a normal individual?

A pediatric neurology consult was placed for a 5-day-old, full-term newborn with macrocephaly. When formally measured his head circumference was 46 cm. A tense fontanelle was appreciated on examination. A bedside ultrasound was performed and the only abnormality appreciated was significant hydrocephalus. What is the most likely etiology of the patient’s symptoms?

A 28-year-old female is brought to the emergency room by her husband because of behavioral changes and memory issues over the last 4 days. Right after the MRI, shown below, the patient had a tonic-clonic seizure. Based on the limited clinical history and imaging provided, which of the following is the most likely diagnosis?

Which of the following medications is associated with sudden irresistible attacks of sleep?

A 23-year-old female with relapsing-remitting multiple sclerosis (RRMS) that is well-controlled on teriflunomide presents for routine follow-up. Today she expresses interest in having a child. Which of the following statements regarding multiple sclerosis and pregnancy is true?

An MRI is ordered on a man with a known history of ischemic stroke and bilateral upper extremity weakness. Which of the following was the most likely cause of his ischemic injury?

Which of the following botulinum serotypes cleaves synaptosomal-associated protein (SNAP)-25.

A 12-day-old male is brought to the pediatrician by his mother with a two-day history of rash. The child was born full-term to a G2P2 mother with good APGAR scores. On physical exam, the pediatrician notes that the child has a pink, crusting, maculopapular rash over his buttocks, thighs, and soles of his feet. She states that a week after his birth he had the “sniffles” and a lot of white discharge from his nose. On exam, there is hepatomegaly and generalized lymphadenopathy. Which of the following is the most likely cause of the patient’s symptoms?

The following gross pathologic coronal section is presented to you for evaluation. The area shown by the black arrow is a sign indicative of which of the following disorders?

A 55-year-old female with a past medical history of coronary artery disease and ischemic stroke with residual mild left arm weakness presents with headaches for a year. Episodes occur two to three times a month. The pain is unilateral and is associated with nausea and photophobia. During this episode, she is unable to go to work and over-the-counter anti-inflammatories have been ineffective. Physical exam and vitals are normal. Which abortive therapy is the most appropriate next step in management?

What task is likely being performed during this EEG recording?

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

An 8-year-old boy with no significant past medical history is brought to the clinic due to difficulties in school. His mother states that over the past year, she has received multiple phone calls from his teacher about his lack of concentration in class. On multiple occasions when asked a question, the patient would blankly stare at the wall and ignore the teacher, but then would return to his normal, talkative self immediately after each episode. An EEG is ordered, which shows 3 Hz generalized spike and wave discharges. The patient would most likely benefit from a medication targeting what?

Which of the following forms of Charcot-Marie-Tooth (CMT) disease causes axonal polyneuropathy?

A 35-year-old woman with a past medical history of ocular and oral dryness presents with a 5-month history of progressive difficulties with ambulation. On exam, there is diminished vibratory sensation along the plantar/dorsal surfaces of her feet, 1+ ankle reflexes bilaterally, and a positive Romberg sign. Strength is normal. A tissue biopsy confirms the diagnosis. Which of the following is the most likely diagnosis?

Which of the following is the thalamic relay center for proprioception of the face?

A critically ill 1-month-old has cerebral vessel imaging performed and shown below. Which of the following comorbid medical issues are likely present?

A 6-month-old boy with no significant past medical history is brought to the clinic by his father because of abnormal limb movements that occur multiple times a day. His father describes high-frequency, low amplitude rhythmic movements that start in the child’s head and quickly spread down the shoulders. Episodes last approximately 1-2 seconds. There are no clear triggers and there is no loss of consciousness associated with the events. Family history is significant for essential tremor in the patient’s mother. Which of the following is the most likely diagnosis?

A 48-year-old woman presents with acute onset of seizures, myoclonus, ataxia, and rapidly progressive dementia. CSF analysis reveals an elevated protein and mild pleocytosis. Brain MRI with and without contrast is unremarkable. Further investigation reveals elevated thyroid-stimulating hormone levels and anti-thyroid peroxidase antibodies. Which of the following is the most appropriate therapy?

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

A 73-year-old male with a past medical history of hypertension, hyperlipidemia, and atrial fibrillation presented to the emergency room with an acute onset of language difficulties. On examination, his speech is nonsensical but fluent. He is unable to understand commands, but repetition is intact. Which of the following best describes this patient’s aphasia?

An 80-year-old female presents with abnormal eye movements and cognition. She has also been experiencing problems with gait and memory. An MRI of the brain revealed midbrain atrophy, with relative sparing of the other brainstem structures. Which of the following is the most likely diagnosis?

What is the mechanism of action of dabigatran?

A 37-year-old female with a past medical history of obesity presented to the emergency room with a severe headache and visual disturbances. The funduscopic exam shows bilateral papilledema. An MRI of the brain shows an empty sella and MRV was normal. A lumbar puncture was performed. The opening pressure was 38 and there were no WBCs or RBCs appreciated in the CSF. What is the most appropriate therapy for her disease?