Quiz 06/28/2022

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?

Which of the following can be appreciated on histopathologic analysis of ischemic tissue five hours after an ischemic injury to the cortex?

A two-month-old boy is brought to the Emergency Room by his mother because of lethargy for the past 3 hours. His mother states that earlier today the child rolled off the couch and hit his head on the hardwood floor. Physical exam shows excessive somnolence, tense anterior fontanelle, and fundoscopic exam shows bilateral retinal hemorrhages. A non-contrast CT of the head shows subdural hematomas of varying ages. A CT head is ordered and pending. Otherwise, what is the next most appropriate step in the management of this patient?

Which of the following nerve conduction study abnormalities is least likely to be seen during the initial phase of acute inflammatory demyelinating polyneuropathy (AIDP)?

A 78-year-old male with a past medical history of depression and chronic alcohol use presents to the clinic with his wife for evaluation of a tremor. He states that the tremor is most severe at rest and disappears with purposeful movement. His wife states that he has been having slower movements over the past year. On physical exam, a “pill-rolling” resting tremor is noted in his left hand and the patient has difficulty with gait initiation and takes short steps when walking forward. Which dopaminergic pathway is most likely affected in this patient?

A newborn is evaluated in the NICU hours after birth to a G1P1 mother with poor prenatal care at 36 weeks. Upon evaluation, the newborn is macrocephalic, jaundiced, and hypotonic. She also has a faint purpuric rash on her extremities and redness of both eyes. CT of the head shows periventricular and basal ganglia calcifications. This condition is likely caused by which of the following organisms?

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?

In the diagram below, what neurologic information is carried by the tract labeled with the green arrow?

Which is the following potentials on EMG has an irregular firing pattern?

A patient recently diagnosed with multiple sclerosis was started on an oral disease-modifying therapy (DMT) that works on nuclear factor erythroid-derived 2-related factor (Nrf2)-dependent and independent pathways. One week later they call you complaining of flushing of the skin. What is the most appropriate next step in management?

A 68-year-old male presents with complaints of insomnia for 2 years. On further questioning, he also endorses a 2 years period of feelings of guilt about his sleeping, considerably low appetite (current BMI = 17), and low energy. He used to enjoy checkers but has lost interest in most activities these days. He denies suicidal ideation. He has previously declined medications to help with this, but he says he is ready to try something. Which of the following medications is most appropriate?

The axial T2 brain MRI image shown below is from a 20-year-old man who presented to the hospital after experiencing a motor vehicle accident. Which of the following associated findings would be expected given the abnormality shown?

Damage to which of the following muscles can lead to scapular winging?

A 19-year-old woman presents for evaluation of paroxysmal episodes of vertigo, spasticity, diplopia, and ataxia. She reports that her father and one of her two sisters have similar ailments. At the time of the appointment, there was no diplopia or ataxia appreciated. Myokymia was appreciated on electromyography. Which of the following is the most likely diagnosis?

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 9-year-old boy with no significant past medical history was referred to get an EEG because of declining school performance and concern for staring vs. daydreaming episodes. Hyperventilation was performed and shown below. His EEG was otherwise unremarkable. Based on the available data which is the most appropriate next clinical step?

The pathology shown in the image below is most consistent with which of the following?

Which of the following medications is an acetylcholinesterase inhibitor that is FDA approved in the U.S. for the treatment of severe Alzheimer’s disease?

A 17-year-old female with a past medical history of anxiety, depression, and irritable bowel syndrome presents to the emergency room after a transient clinical episode. Her mother states that they were eating dinner when her daughter dropped to the floor and began having generalized shaking movements of her arms and her legs. She was unresponsive during the event and her eyes were closed. The event lasted approximately 30 seconds and there was no post-ictal confusion. In the emergency room, the patient has another event, where pelvic thrusting and asynchronous movements were appreciated for 2 minutes before resolution. The patient stated that she remembered having no control of her body during the event in question. Based on the most likely diagnosis, which of the following is the most appropriate treatment?

A 36-year-old female with a history of renal cell carcinoma with headaches and slight right arm/leg ataxia had an MRI of the brain that showed a contrast-enhancing lesion in the right cerebellum. Surgical resection was completed and histology of the lesion is shown below. This patient most likely has which of the following diagnoses?

Stiff person syndrome is associated with which of the following auto-antibodies?

Based on the MRI imaging shown below, which of the following structural abnormalities is likely also present?

What is the electrographic pattern seen best in the right temporal electrodes?

What is the pathophysiology of the lesion provided below?

A 6-year-old male is brought to the pediatrician with multiple-decaying teeth since 2-3 years of age with no associated pain. He was born via C-section at term with no complications. Past medical history is significant for developmental delay and intellectual impairment. On physical exam, the patient is short-statured and obese with hypogonadism. His parents state that he has always been an overeater. What is the most likely diagnosis?

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

Charcot Marie Tooth disease (CMT) is associated with which of the following pathologic findings?

Which of the following is not a risk factor for the development of natalizumab-associated PML?

What sensitivity should the EEG be at to qualify for brain death criteria?

A full-term male is having a routine awake and sleep EEG performed because of episodes concerning for possible seizures. These episodes were first noticed four days after an uncomplicated vaginal delivery. On the video EEG recording, you notice a violent jerking of the limbs followed by sustained stiffening after a phone rings loudly in the room. What is the most likely diagnosis?

A 25-year-old male with a history of sensorineural hearing loss and tinnitus has an MRI brain ordered as part of his workup (see below). A genetic syndrome is suspected. Which of the following is also likely to be found on imaging?

A 74-year-old male with a past medical history of hypertension and hyperlipidemia is brought to the physician by his daughter who states that he has been exhibiting abnormal shaking of his hands and difficulty walking for the past year. On exam, the patient exhibits a shuffling gait, a tremor of his left hand at rest, and difficulty initiating movements. Which of the following is the most appropriate first-line therapy?

The pathophysiology of the lesion shown in the gross pathologic image below is most likely which of the following?

A 67-year-old woman with a past medical history of osteoporosis, hypertension, bipolar disorder, and a remote right MCA stroke is referred to the epilepsy clinic after experiencing her first epileptic seizure. An EEG has shown right temporal epileptiform discharges. Which of the following medications are most appropriate to start as initial therapy?

A 53-year-old man has had increasing difficulty falling and staying asleep over the past 3 months. This is accompanied by hallucinations, delirium, and general clumsiness. He was an orphan as a child and does not know his family’s medical history. If a sleep study is performed, during which stage of sleep would you most likely expect to find an absence of normal sleep architecture?

Which of the following medications do not worsen myasthenia gravis symptoms?

A 40-year-old man is seen in the clinic with the chief complaint of headaches. He endorses a unilateral stabbing-like pain around the temple. This pain lasts 10-30 seconds at a time and occurs dozens of times a day. There were no clear triggers. There is associated ipsilateral conjunctival lacrimation and rhinorrhea. What is the most likely diagnosis?

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

A 12-year-old male is brought to the clinic accompanied by his father who states that for the past 4 months he has been randomly flailing his arm during class and calling out in the middle of the teacher’s lectures. He has been sent to the principal’s office twice in the past month for his disruptions. His father states that this is very out of character for him. In the clinic, the patient has intermittent movements of his right arm, where he raises his arm above his head and then slaps it down on his leg. Additionally, during the exam, he blurts out words that do not make contextual sense in the conversation. Two months later, the patient follows up with his father who states that all of the abnormal movements and vocalizations have resolved. What is the most likely diagnosis?