Quiz 06/27/2022

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

Cerebral amyloid angiopathy would be best appreciated on which of the following MRI sequences?

An 82-year-old woman donated her brain to science for post-mortem analysis (see below). Which of the following symptoms did the patient most likely experience before her passing?

Identify the finding shown in the EEG below:

A 65-year-old male comes into the office with his wife for follow-up after a recent hospitalization for HSV encephalitis.  The wife says before his hospitalization, he used to be a quiet, shy man but recently has been making sexually inappropriate remarks to women at the park. The patient also has an increase in appetite and an urge to touch everything at the grocery store. Based on his cognitive deficits, which of the following areas of the brain is likely affected?

A 77-year-old male presents with a 1-year history of worsening bradykinesia, recurrent falls, and a shuffling gait. Past medical history is significant for REM-sleep behavior disorder and diet-controlled hypertension. Neurologic examination reveals a tremor at rest that improves with movement, along with bilateral upper-limb spasticity. Impaired dopaminergic signaling is most likely to be found in which of the following locations?

A two-month-old female presents to the clinic with her mother for episodes of abnormal posturing of her head, neck, and abdomen when breastfeeding. Her mother states that the episodes last approximately 30 seconds to 1 minute. Episodes are followed by crying. Her birth history was normal, and she has met all of her developmental milestones. Of the following, what is the best treatment for this patient’s condition?

A 58-year-old woman presents with worsening memory loss and a 50-pound weight gain over the past six months. On neurological exam, her Mini-Mental Status Examination (MMSE) yields a score of 21/30. She has intact sensation, normal muscle bulk, tone, and strength, but diffuse hyporeflexia. Which of the following is most likely the diagnosis?

A 67-year-old male wakes up with a painful, right-sided, itchy rash coming across his abdomen like a band involving the umbilicus. His primary care provider is concerned that the patient has shingles. For this patient, re-activation of the varicella-zoster virus occurred at the dorsal root ganglion at which thoracic level?

A 27-year-old woman presents with recurrent episodes of tinnitus, vertigo, and hearing loss. She denies any associated headaches. Episodes typically last between 2 and 6 hours in duration. MRI of the brain with and without contrast did not reveal any pathology. Physical examination is unremarkable except for sensorineural hearing loss appreciated in the right ear. Which of the following is the most likely diagnosis?

A 63-year-old female presents to the office, accompanied by her husband who has become increasingly worried about his wife’s ability to perform tasks at home. He states that for the past three months she has not been able to tie her shoes, and fumbles with the shoelaces in her hands. Additionally, within the past month, she has not been able to brush her teeth, and simply holds the toothbrush in her hand, without moving. Lastly, her husband has noticed that the patient moves slower on their morning walks together, and her arms and legs seem more tight and rigid. A brain MRI is ordered which shows asymmetric atrophy of the superior parietal lobule. Which of the following is the most likely diagnosis?

Which of the following EEG artifacts is prominently seen on this EEG?

A 32-year-old woman with a known history of relapsing-remitting multiple sclerosis currently on ocrelizumab presents to the emergency room with the concern of having a demyelinating attack. An MRI brain with contrast shows a single, ovoid, juxtacortical white matter lesion with contrast enhancement that was not present on her last MRI scan. Which of the following is the most appropriate next step in medical management?

Which of the following is the most common gene associated with early-onset Alzheimer’s disease?

A 32-year-old female comes into the clinic with a continuous, throbbing headache for 5 months. The pain is unilateral near the temple. The headache is constant but there are periods of pain exacerbations that can last from minutes to days and are debilitating. There is associated lacrimation and rhinorrhea on the ipsilateral side. What is the most likely diagnosis?

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?

A 68-year-old woman with no significant medical history presents in the emergency room with acute aphasia and right-sided weakness. Her wife who is in the room states the patient was last seen well one hour prior to arrival at the hospital. A CT scan of the head showed no acute hemorrhage. After screening the patient and discussing the risks and benefits of acute pharmacological therapy with her significant other the patient was given intravenous tPA. Thirty minutes later the patient had an acute neurological decline. She was sent for a repeat CT scan which showed a new 16 cc intraparenchymal hemorrhage in the left hemisphere. What is this an example of?

A 17-month male was brought to the pediatric neurology clinic was brought to the clinic with concerns for developmental delay. Parents note that the child was a product of a normal pregnancy and his delivery was uncomplicated. A developmental delay was appreciated by 8 months of age. He is largely non-verbal. He appears happy in the room, laughing spontaneously without any external stimuli. Which of the following abnormalities most likely explains this developmental disorder?

A 38-year-old man with a past medical history of HIV, depression, and asthma presents after experiencing a first-time seizure. He was last seen normal about 45 minutes ago by his husband, who witnessed him seizing for about 10 minutes. A CTH is performed and normal. A lumbar puncture is performed and reveals the findings below. Which of the following is the most likely cause of the patient’s symptoms?

Identify the structures labeled in the image below:

Which of the following arteries supplying the thalamus provides supply to the lateral geniculate nucleus (LGN)?

A 24-year-old weight-lifter presents after sudden-onset neck pain. On exam, there is right eye ptosis and asymmetric right pupil constriction. Additionally, the patient appreciated decreased sweat production on the right side of his face. 1% hydroxyamphetamine eye drops are administered to the right eye and it dilates. Where is the most likely site of the patient’s lesion?

A 56-year-old female with a past medical history of IgA deficiency presents to the emergency room with a 4-day history of progressive, ascending lower extremity weakness. Neurological examination reveals flaccid paralysis of the bilateral lower extremities and areflexia. Imaging of the lumbar spine shows contrast enhancement of the cauda equina and CSF studies show elevated proteins and a normal WBC count. What is the most appropriate next step in therapy?

A 6-month-old previously healthy male is seen in your clinic due to feeding difficulties and weakness for the past 8 days. The mother reports that he has also not had a bowel movement in 3 days. On physical exam, the patient demonstrates a weak cry, severe hypotonia, and hypo-responsiveness. No one else in the family is sick, however, they have been eating homemade molasses for the past 4 weeks. This patient’s condition is caused by a toxin affecting which structure?

A 45-year-old female with a past medical history of hypertension and medication non-adherence presents to the emergency department with weakness on the left side of the body and a drooping right eye. Her blood pressure is 220/100. On physical exam, her right eye is inferiorly and laterally deviated and the pupil is non-reactive. Her strength was 3/5 on the left side. MRI brain identifies an ischemic lesion. Based on the clinical exam, which of the following arteries is most likely the cause of the patient’s symptoms?

A 65-year-old female with 40 pack-year history presents with a 2-week history of generalized weakness that improves with repeated testing. You are concerned for Lambert-Eaton myasthenic syndrome (LEMS). Which of the following statements is incorrect regarding LEMS and/or myasthenia gravis (MG)?

An 8-year-old girl is noted to have staring spells during class by her teacher. In the office, you are able to provoke an event by having her blow repeatedly into a pinwheel. What is the most likely underlying pathology of her disease?

Which of the following is the resting membrane potential of a neuron?

A four-day-old, full-term male with an uncomplicated vaginal delivery is brought urgently by his mother to the clinic after an episode concerning for possible seizure. His mother states that this morning when she accidentally dropped a pile of dishes on the floor, the child “tensed up”. She states that both his upper and lower limbs became rigid and he had violent jerking movements of all limbs for approximately 40 seconds. This patient’s condition is most likely due to a mutation in which of the following genes?

Gaucher disease is caused by a homozygous mutation in the GBA gene which encodes the enzyme beta-glucocerebrosidase. Which of the following neurologic disorders is also linked to mutations, both homozygous and heterozygous, in the GBA gene?

A 44-year-old woman who was recently started on a new abortive therapy for her migraines presents with a new type of headache described as more severe and with an extremely rapid onset. CT head imaging revealed no acute findings and lumbar puncture testing was unremarkable. Which of the following is the most likely diagnosis?

A 23-year-old female with a history of optic neuritis presents with a 1-week history of left leg weakness. Neurologic examination reveals decreased strength of the left lower extremity. A lumbar puncture reveals oligoclonal bands with lymphocytic pleocytosis. What stain can be used to identify the dysfunctional cells in this condition?

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 findings is depicted in the vessel imaging shown?

A 25-year-old woman with no significant medical history comes to the clinic for a routine physical exam. During the interview, she states that she is in a relationship with a famous singer for the last three months. She says his song lyrics are about her and his social media contains hidden messages that only she understands. The singer recently filed for a restraining order, but the patient says that’s “just for show.” She works at a local coffee shop and just recently got a promotion to manager. She denies any drug or alcohol use and takes no medications. Which of the following is the most likely diagnosis?

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?

The EEG pattern on this bipolar EEG recording is most consistent with which of the following epilepsy syndromes?

Concentrically-layered Schwann-cell processes (“onion bulbs”) are seen surrounding nerve fibers on nerve biopsy in which of the following diseases?

Of the following, which extraocular muscle is not innervated by the oculomotor nerve?

Fibrillations and positive waves are first seen on electromyography (EMG) at which point following a nerve transection?