Quiz 06/28/2022 (7)

A 30-year-old woman presents to the clinic with severe headaches requesting treatment because she “can’t live with this pain”. Episodes are left-sided, occur multiple times a day, and last about 20 minutes each. During episodes, she will also have eye tearing and rhinorrhea. What is the correct diagnosis?

A 65-year-old female patient presents with right homonymous hemianopsia for the past week. She also says she has difficulty reading but no problems with writing. Which of the following area of the brain is likely affected?

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?

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?

A 39-year-old homeless man presents to the emergency room with fever, headache, and meningismus which has slowly progressed over the past 3 weeks. The patient is lethargic and agitated when aroused. Neurological examination reveals an isolated left abducens nerve palsy. Funduscopic examination reveals blurring of the optic discs. An MRI is performed and shown below. What is the most likely diagnosis?

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 21-year-old man is brought into the clinic by his roommate due to bizarre behavior. For the last 10 months, the patient has been intermittently skipping classes and trying to soundproof his dorm room because he believes the government is watching him. His roommate says that on two separate occasions he caught the patient talking to himself under the bed covers. The neurological exam is normal but the patient refuses to make eye contact and his speech is pressured and tangential. Which of the following is the most likely diagnosis?

A 42-year-old welder complains of a one-year history of progressive resting tremor, shuffling gait, and drooling. He consults a physician because of frequent falls and worsening fatigue. A diagnosis of a particular type of metal toxicity was made and treatment is started. Which of the following would most likely be found if an MRI brain if ordered?

A 32-year-old female presents to the emergency room after a motor vehicle accident as a restrained back seat passenger. Her only complaint on arrival is back pain. She has bruises across her abdomen and chest and a normal neurological exam. Thoracic spine imaging was completed and is shown below. Which of the following 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 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?

Which of the following embryologic derivatives myelinates the peripheral nervous system (PNS)?

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?

What is the mechanism of action of pregabalin?

A chronic alcoholic is admitted to the hospital for altered mental status. An MRI is performed and shown below. What symptoms/signs are most likely seen on examination?