Quiz 06/29/2022

A patient presents with sudden-onset gait instability and dysphagia. On exam, he has dysmetria of the right hand, anisocoria, loss of pain and temperature of the right face, and loss of pain and temperature of the left arm and leg. An MRI of the brain is performed and shows a stroke. What other symptom is often also a part of the syndrome this patient is experiencing?

A 67-year-old male presents with the inability to reach for objects in his visual field. He states that he can see the object, but on the clinical exam he can not grasp it accurately. He also is unable to see multiple objects at once. He has a past medical history of atrial fibrillation and an ischemic injury is suspected. A brain MRI would show which of the following areas of the brain is/are affected?

A 53-year-old male presents with a 3-month history of hypersexuality, visual agnosia, excessive chewing, and lip-smacking. Past medical history is notable for HSV encephalitis 6 months ago, which was treated with IV acyclovir. Based on the clinical history and examination, which of the following would most likely be appreciated on a brain MRI?

A 65-year-old female presents with an abrupt onset of akinetic mutism, lack of motivation, apathy, bilateral leg weakness, and incontinence. A lesion to which of the following vascular territories could explain her symptoms?

A 68-year-old man with an unknown past medical history presents with language difficulties. His spontaneous speech is non-fluent. He has anomia and difficulty following complex tasks, but intact repetition. A solitary lesion in which of the following regions can present with these symptoms?

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 85-year-old woman presents to the hospital with an acute onset of language impairment. On examination, she has difficulty with comprehension but her verbal fluency and repetition are normal. Which of the following best describes her deficits?

A 69-year-old female is brought to the emergency room by her daughter for excessive stumbling, often tripping on things on the floor. The daughter also says her mother has been behaving oddly, complaining about seeing darkness in a fully lit room, and the inability to recognize her family members. Bilateral pupillary light reflexes are normal. If symptoms are secondary to an ischemic injury, an MRI would show a lesion in which of the following regions?

A 75-year-old female with a past medical history of atrial fibrillation and hypertension presents to the ER with garbled speech. She seems unaware that her speech is nonsensical. On physical exam, she is unable to follow verbal commands but can understand visual cues. An ischemic injury is suspected. If this is true, a brain MRI would show which of the following areas of the brain is/are affected?

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 presents with complaints of hearing a strange “clicking sound” all of the time which started suddenly 6 weeks ago. On exam, you note a rhythmic tremor of the upper palate. The patient also has pendular horizontal nystagmus. Which MRI finding is most likely?

A 65-year-old male with a past medical history of diabetes, hypertension, and a 40-pack-year smoking history comes into the ED with an acute onset of ataxia, left facial numbness, right arm, and leg numbness, and dizziness. He also has intractable hiccups. A CTA angiogram shows the cause of the patient’s symptoms. Based on the clinical exam, which of the following arteries is occluded?

A 73-year-old male with a past medical history of hypertension, hyperlipidemia, and atrial fibrillation presented to the emergency room with an acute onset of language difficulties. On examination, his speech is nonsensical but fluent. He is unable to understand commands, but repetition is intact. Which of the following best describes this patient’s aphasia?

While on the consult service you are called to see a patient from the surgical ICU whose hospital course has been complicated by a prolonged episode of ventricular tachycardia and hypoperfusion. After a return to spontaneous circulation, an MRI is performed due to concerns for ischemic stroke. MRI shows bilateral parietal-occipital hyperintensities on diffusion-weighted imaging consistent with watershed infarcts. Once he recovers from his cardiac event, what neurologic symptoms would you expect based on the MRI findings?

A 39-year-old male presents to the clinic for hallucinations. His medical history is only remarkable for a chemical accident at his job resulting in severe corneal scarring bilaterally, for which he now requires a seeing-eye dog.

His hallucinations are usually of tall figures dressed in black with long fingers. He is not frightened by this because he knows they are not real. He denies other neurologic deficits, denies auditory hallucinations and describes his mood as “good”. The rest of his exam is normal.

You are familiar with the underlying syndrome the patient is experiencing. You inform the patient that in the rest of the population the most common cause of this syndrome is actually…

You are caring for a 65-year-old that sustained a small hypertensive intracranial hemorrhage. Early physical therapy is initiated. They discover that while she can sit unassisted, she is unable to stand. When standing, she sways and falls forward, backward, or to one side. On a detailed physical exam, strength is 5/5 to flexion and extension at the ankle, knee, hip, shoulder, elbow, and wrist bilaterally.

Which of the following locations of the bleed best explains this finding?

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 56-year-old male presents with unusual behavior of compulsive eating and inappropriate sexual gestures. On exam, the patient has difficulty keeping his hands to himself and is distracted by the objects in his bed. A lesion in which area(s) of the brain would explain this syndrome?

Which of the following is not part of Gerstmann’s syndrome?

A 75-year-old female with a past medical history of hypertension on lisinopril presents to the emergency department with weakness on the left side of the body and a drooping right eye. On exam, her right eye is inferiorly and laterally deviated. This pupil is also non-reactive. Her strength is 3/5 on the left side. Where is this patient’s lesion?

Socially inappropriate behavior, disinhibition, echopraxia, and utilization behavior are typically seen in which of the following?

A 56-year-old right-handed man is brought to the emergency room for new-onset aphasia. On exam, he cannot write, perform simple calculations, name his own fingers, and cannot distinguish with accuracy between his right and left sides. A lesion in which area can explain his symptoms?

A 40-year-old male is brought to the emergency room unresponsive after getting into a motor vehicle accident. On physical exam, his pupils are equally reactive to light. He can close his eyes and look up and down but not side to side. His motor exam otherwise has 0/5 strength symmetrically. The Babinski reflex is upgoing bilaterally. These symptoms can be explained by occlusion of which of the following vessels?

A 19-year-old college student presents with an inability to look up at the board in class. On exam, he has upward paralysis but with preserved downward gaze. Pupillary accommodation is normal, but they remain dilated with the light shining. Where is the most likely location of the lesion?

An MRI is ordered on a man with a known history of ischemic stroke and bilateral upper extremity weakness. Which of the following was the most likely cause of his ischemic injury?

Which of the following symptoms can be seen with MCA-PCA watershed infarcts?