Quiz 06/28/2022

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 37-year-old woman treated for herpes simplex virus (HSV) encephalitis two months ago returns to the ER with new personality changes, seizures, and orofacial dyskinesia. What is the most likely diagnosis?

A consult is placed for paroxysmal episodes in a 6-day-old male infant born at 32 weeks gestation. According to his mother, the infant seems to be shivering a lot “like he is cold”. The mother states that she has been wrapping him in warm blankets and keeping the room at a warm temperature. On physical exam, the infant is alert and interactive, without persistent focal neurological deficits. However, when touching the left arm, the patient develops a fine tremor that resolves after flexing the affected limb. Vital signs are within normal limits. Which of the following is the most likely diagnosis?

A 22-year-old female with chronic daily headaches and other neurological symptoms has an MRI performed as part of her diagnostic workup. Her cervical MRI imaging is provided below. In addition to her chronic daily headaches, what are the most likely additional neurological symptoms she experiences?

A 42-year-old woman presents to the clinic with a 2-month history of distal symmetric hand weakness that started after hospitalization for severe abdominal pain. Before this hospitalization, she was drinking alcohol with her friends when she acutely developed severe abdominal pain, nausea, restlessness, altered mental status, and hallucinations. She was noted to have dark urine at the time of admission. Since then, her GI symptoms and mentation have returned to baseline, but her weakness has persisted. On exam, she has 3/5 strength of the intrinsic muscles of the hand bilaterally. Conduction velocities of the bilateral upper extremities were unremarkable. Needle EMG revealed fibrillations and decreased recruitment of motor unit action potentials in muscles innervated by the radial and ulnar nerves. Which of the following is the most likely cause of the patient’s symptoms?

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?

An 8-year-old child with a past medical history of tuberous sclerosis presents urgently to the emergency room with lethargy. Funduscopic examination shows blurring of the optic discs. An MRI is performed and shown below. Which of the following is the most likely cause of the patient’s symptoms?

A 6-year-old developmentally normal male presents after experiencing an episode of jerking of the right side of his mouth and inability to speak lasting 2 minutes. The patient is now back to baseline and has an EEG performed. Based on this clinical picture, which of the following abnormalities would you most expect to see on the EEG?

What is the anatomical structure labeled “C” below?

Which of the following medications is the first-line treatment for trigeminal neuralgia?

A patient presents to the emergency room with sudden onset weakness and dysphagia. On exam, the patient’s tongue deviates to the left, and there is right hemiparesis and right-sided loss of position and vibratory sensation. Pain and temperature sensation is intact. Which of the following arteries supplies blood to the damaged area?

A 62-year-old male with a past medical history of hypertension, type 2 diabetes, and dyslipidemia presents with a stepwise progression of worsening forgetfulness over the last three years. Physical examination reveals a score of 20/30 on the Mini-Mental State Examination with deficits in multiple cognitive domains. Hyperreflexia in the left upper and lower extremities is also appreciated. Her axial FLAIR sequence brain MRI scan is shown. Which of the following is the most likely diagnosis?

A 47-year-old woman from the Caribbean presents to the clinic with a seven-year history of progressive difficulty with ambulation. The exam is notable for lower extremity spasticity. An MRI is ordered and shows atrophy of the spinal cord without other changes. The clinical and MRI findings for this patient are most likely secondary to which of the following infections?

A 55-year-old male presents with progressive worsening new headache over several months. He did not wish to seek medical attention but now presents because his family reports his facial expressions “look different”. On exam, he has impaired upgaze, light near dissociation, and convergence retraction nystagmus. An MRI is done and shows a lesion. Where is the lesion likely located?

Bilateral exotropia is typically seen with which of the following lesions?