Quiz 06/27/2022 (2)

A 75-year-old man with a past medical history of hypertension, hyperlipidemia, and diabetes presents with acute onset right arm weakness and speech problems. He can speak fluently and his comprehension is intact. However, he is unable to repeat even simple sentences. Reading and writing are preserved. Which of the following is an accurate description of his speech dysfunction?

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?

A patient with a history of hypertension and provoked seizures secondary to posterior reversible encephalopathy syndrome (PRES) has come to your clinic for a 6-month follow-up after her associated hospitalization. It was found that abrupt discontinuation of her hypertensive medications due to medication noncompliance was the cause of the PRES. She was started on the anti-seizure medication (ASM) levetiracetam at the time of her PRES and has had no seizures since being discharged. She asks you about the risk of future seizures. What is the most appropriate response?

Which of the following is an absolute contraindication for the use of tPA?

Which of the following arteries is the first branch of the internal carotid after it enters the cranial cavity?

An 83-year-old man presented with an acute onset of difficulty walking and nausea about 12 hours prior to being seen in the emergency room. Examination revealed vertigo and truncal ataxia. An MRI was performed to evaluate for stroke. The FLAIR axial MR image is shown below. What is the vascular territory damaged in the imaging provided?

An MRA is ordered for a patient presenting with an acute stroke. Based on the lesion appreciated in the image below (white arrow), what symptom is likely to be seen on examination?

A patient with a history of a chronic ischemic stroke has an MRI performed for new-onset seizures. Based on the imaging provided, what is the likely etiology of the patient’s past stroke?

Which of the following is the reversal agent for apixaban?

A 39-year-old male presents with right-sided weakness and aphasia. NIHSS is 22 on physical exam. He was last known well 2.5 hours prior. The past medical history does not reveal any contraindications to tPA. A CT head is done and shows a hyperdense left MCA sign. The tPA is mixed by the nursing staff while you consent his wife for its administration. When you return to the bedside his aphasia has improved but his NIHSS is still 13. The blood pressure is 189/105 and the glucose is 225. What is the most appropriate next step?

A 65-year-old right-handed man presents with acute onset speech difficulties, a mild right-sided facial droop, and right-sided arm weakness. While talking to his wife over breakfast this morning he suddenly stopped speaking and could only make unintelligible sounds. On examination, he is unable to speak any words but has intact comprehension. He is able to write clearly what he wants in full sentences with intact grammar and reading is also preserved. Which of the following best describes his language deficit?

Which of the following findings is depicted in the catheter angiogram shown?

Which of the following findings is depicted in the catheter angiogram shown?

A 40-year-old male with a history of headaches, seizures, and recurrent strokes has a brain biopsy performed to aid in diagnosis. Electron microscopy of his brain tissue shows granular osmiophilic material in the basal lamina of small cutaneous arterioles. What is the cause of this patient’s disease?

What is the pathophysiology of the lesion provided below?

A 7-year-old girl presents with 2 weeks of a right-sided unilateral throbbing headache. She has otherwise been healthy with no other symptoms and has no past medical history except for a light pink birthmark around her right eye. What is the most appropriate next step?

A 32-year-old man with no significant past medical history presents to the emergency department after experiencing a generalized tonic-clonic seizure. His neurological examination was unremarkable. As part of his work-up, an MRI was obtained (see FLAIR axial image below). What is the most appropriate next step in management?

The MR angiogram shown below demonstrates which of the following?

An 82-year-old female patient with a history of atrial fibrillation is brought to the emergency department after being found down at home. She is unable to move her extremities, although she is able to blink and move her eyes vertically. Occlusion of which artery/arteries is the most likely cause of her symptoms?

What is the mechanism of action of apixaban?

Identify the lesion below.

Which of the following findings is depicted in the catheter angiogram shown?

A 56-year-old man with a past medical history of hypertension and type II diabetes presents to the hospital with acute onset left-sided weakness which started 90 minutes prior to your evaluation. His only medications prior to admission were metformin and verapamil. Vitals were within normal limits except for a blood pressure of 154/92. Physical examination reveals 3/5 weakness in the left arm, leg, and face as well as a moderate sensory disturbance in the same regions. CT head was unremarkable and CT angiogram (CTA) showed no large vessel occlusion. A brief history gathered from his wife revealed no other comorbidities or active medical issues. At this point in his clinical presentation, what is the mechanism of action of the most appropriate therapy?

Which of the following is the most likely cause of the findings appreciated on the axial CT head shown below?

Which of the following diseases does not contribute to the pathology appreciated in this pathology image?

A 90-year-old woman presents to the emergency room with an acute change in mental status. On examination, she is alert but is not answering questions or following commands. Speech is fluent, but not interpretable. Comprehension is severely impaired. Interestingly she was able to repeat full sentences without much difficulty. Which of the following is the most likely territory of ischemic damage?

A 26-year-old female with a past medical history of pulmonary embolism presents with seizures and left-sided weakness. She had been complaining about a headache for the past week. An MR venogram is shown below. Which of the following is the next best step in management?

A 58-year-old female with a history of atrial fibrillation on warfarin presents to the ED with aphasia and right-sided weakness. She was last seen well 2 hours prior. CT imaging is unremarkable. Which is the most appropriate next step?

A patient with a recent history of ischemic stroke with almost no residual focal deficits except for a mild right-sided facial droop presents to the emergency room with altered mental status. Vital signs are only impressive for a low-grade fever. CT head and CTA show no acute changes when compared to imaging completed for his initial stroke. Blood work shows thrombocytopenia, anemia, and renal failure. A severe drug reaction is suspected. Which of the following medications is most likely the cause of this clinical presentation?

Which of the following is not a risk factor for carotid dissection?

A 12-year-old boy with a past medical history of sickle cell disease was admitted to the emergency room in a pain crisis. While being treated with morphine the patient developed acute left arm/leg weakness and numbness. Which of the following is the most likely etiology for the patient’s new neurologic symptoms?

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

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?

Identify the lesion below.

A 32-year-old female with an acute ischemic stroke was sent for an urgent angiography. Below is the image captured from this study. What is the likely etiology of the patient’s acute ischemic stroke?

Which of the following findings is depicted in the vessel imaging shown?

Which of the following findings is depicted in the vessel imaging shown?

The pathology shown in the image below is likely secondary to which of the following?

Which of the following vessels drains into the sigmoid sinus?

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

What is the mechanism of action of dabigatran?

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

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

A 72-year-old male with diabetes, hyperlipidemia, and tobacco abuse is admitted to the stroke service after he is found to have a left superior middle cerebral artery territory stroke. His EKG on admission showed a normal sinus rhythm. A transthoracic echocardiogram (TTE) is performed. Which of the following findings on TTE would lead to the recommendation of an anticoagulant medication over an antiplatelet medication for secondary stroke prevention?

Which of the following is the most likely cause of the findings seen on this gross pathology image?

A 34-year-old man was admitted to the hospital and intubated after a severe motor vehicle accident leading to multiple bone fractures two days ago. Despite weaning IV sedation, the patient continues to be unarousable to stimulation. An MRI was performed and DWI imaging is shown below. What is the most likely diagnosis?

A 68-year-old woman with a history of diabetes and hypertension presented urgently to the ED with a 2-day history of headaches and confusion. Before any imaging was able to be completed in the emergency room, the patient had a cardiac arrest and died. An autopsy was requested by the family. A gross pathologic image of the patient’s brain is shown below. What is the most likely etiology of the findings seen in this image?

Which of the following findings is depicted in the catheter angiogram shown?

How long ago did the ischemic injury seen on this neuronal tissue micropathology slide occur?

Which of the following is the reversal agent for dabigatran?

How long ago did the ischemic injury seen on the micropathology slide below of neuronal tissue occur?

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 45-year-old man comes into the ED complaining of a severe headache. A spinal tap shows xanthochromia. The patient is treated immediately and spends the next two weeks in the neurocritical care unit. On day nine of his stay, his speech becomes slurred and the neurologist notices that the left side of his face is drooping. What is the class of drugs that could have potentially prevented these findings?

A 41-year-old male presents to the emergency room with a two-day history of neck pain and speech difficulties. CT head shows scattered hypodensities in the left ACA and MCA territories. His Sagittal CT angiogram of the neck is shown below. What is the most likely cause of the patient’s symptoms?

Which of the following medications is associated with the occurrence of reversible cerebral vasoconstriction syndrome (RCVS)?

Which of the following is not one of the absolute exclusionary criteria for tissue plasminogen activator (tPA)?

A 74-year-old female presents to the ED for trouble with swallowing and balance. On physical examination, she is unable to speak clearly and has no gag reflex. Pain and temperature sensation on the right side of her body and the left side of her face is decreased. She is unable to walk unassisted and has dysmetria on the finger-to-nose exam. MRI of the brain shows an ischemic stroke. The artery that is affected most commonly branches off of which of the following?

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 68-year-old right-handed male with HTN and atrial fibrillation formerly taking Eliquis, but stopped months ago due to GI bleed, presents for acute onset neurologic symptoms. He is able to understand speech and commands, however, he is unable to speak fluently and can not get the right words out. Despite this, he is able to accurately repeat words you say and correctly name items that are pointed to. What other neurologic symptom is also likely to be present on the exam?

What is the mechanism of action of abciximab?

Which of the following medications can potentially reduce the platelet inhibition of clopidogrel?

What is the pathophysiology of the lesion provided below?

A 67-year-old man presents urgently to the emergency room with an acute onset of left-sided weakness and numbness. A CT head was performed and shown below. What is the most likely etiology of the patient’s symptoms?

A previously healthy 59-year-old male presents with an acute onset of slurred speech and left-sided weakness. The symptoms started 7 hours ago. On arrival, his NIHSS is 8 and his EKG shows a normal sinus rhythm. Vessel imaging is done and shows a right middle cerebral artery occlusion, so the patient undergoes a successful mechanical thrombectomy and has minimal residual neurological deficits. A post-thrombectomy CT head is performed and negative for blood. Which of the following options is the most appropriate next step in medical management?

What is the mechanism of action of clopidogrel?

A 32-year-old female who is currently 39 weeks pregnant was brought to the emergency room after experiencing a first-time seizure. Neurological examination is non-focal except for mild somnolence and decreased visual acuity in both eyes. Vitals signs were normal except for a blood pressure of 192/104 mmHg. An MRI was performed and shown below. Which of the following is the most appropriate step in management?

The vessel imaging shown below is consistent with which of the following?

A 40-year-old woman of Chinese descent has a cerebral angiogram performed after experiencing recurrent ischemic strokes over the past 5 years. This image is most consistent with which neurological disease?

Which of the following antiplatelet medications rely heavily on the cytochrome P450 system for its therapeutic effect?

Which of the following syndromes are most likely associated with the lesion shown in the image below?

Which of the following comorbidities are responsible for the lesion appreciated in the image below?

An 18-year-old male with a history of IV drug use was found unresponsive on a park bench by police. He was intubated by EMS and sent directly to the emergency room. The patient is comatose on examination. CT scan of the head is shown below. What is the likely diagnosis?