Quiz 07/06/2022 (1)

Which of the following is the thalamic relay center for proprioception of the face?

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 lesion to which of the following neuroanatomical structures causes dysphagia, decreased gag reflex, and hoarseness?

A 72-year-old man with a history of right-sided carotid stenosis was transferred from an outside hospital to your institution to have a carotid stent placed after experiencing a mild right-hemispheric ischemic stroke. The patient was sent to the angiography lab and had a carotid stent placed, however, it was done so on the unaffected (left) side. What is this an example of?

A 16-year-old male is brought to the emergency room by his parents for generalized weakness. The patient states that he woke up in the morning that day with flaccid paralysis of his arms and legs which was so significant that he couldn’t get out of bed. In typical teenage boy fashion, he wasn’t very worried about this at the time and went back to bed. It wasn’t until 4 hours later when he woke up again with the same degree of weakness that he became concerned and screamed for his parents to help. The patient denies any recent drug or alcohol use. The only interesting thing from the previous night was that he partook in and won a pizza-eating contest with his friends. The patient’s father admits to having had similar episodes to this when he was younger. If the patient’s symptoms are due to a genetic disorder, a mutation in which of the following genes is most likely responsible?

Which of the following is not a risk factor for carotid dissection?

A 62-year-old woman with a history of rheumatoid arthritis presents with insidious onset of painless proximal muscle weakness and atrophy. A serum CK is obtained and is normal. TSH is also normal. Her medication list includes lisinopril, aspirin, and prednisone. EMG shows short-duration motor unit potentials in the deltoids and quadriceps bilaterally. A muscle biopsy is performed. Which of the following will most likely be appreciated?

Which of the following structures is supplied by the recurrent artery of Heubner?

A healthy 24-year-old female was admitted to the epilepsy monitoring unit for spell classification. What state is the patient during this segment of recording?

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 32-year-old man with a 4-week history of painful swelling on his right forehead presents to the emergency room. A CT scan of the head was performed and is shown below. What is the most likely diagnosis?

A 63-year-old female presents with a 6-month history of difficulty walking and muscle weakness. Neurologic examination reveals normal bulk but muscle fasciculations, bilateral extensor plantar responses, muscle spasticity, and hyperreflexia. Pathology at which of the following structures could explain these symptoms?

Which of the following is the most classic finding of early inclusion body myositis?

A 38-year-old man visiting from India presents to your clinic as a new patient for months of weakness in bilateral ankles to dorsiflexion and plantar flexion. On exam, he has diminished reflexes. He had an EMG done recently, showing axonal neuropathy in the lower extremities. He does not have his medication list with him, but he states he has taken a medication prescribed in India for “a cough” for several months. Which of the following labs would provide the highest yield?

A 10-month-old male with no significant past medical history has had a 2-month history of abnormal movements. The family describes these events as head drops and head-turning. On examination, horizontal nystagmus is appreciated. MRI revealed no abnormal findings. What is the most likely diagnosis?

A 69-year-old man with HTN, CKD, HLD, tension headaches, and gout presents for 6 months of slowly progressive weakness. He has trouble rising from a chair without assistance and lifting objects above his head. On sensory exam, you note a bilateral symmetric loss of proprioception, vibration, and light touch in the feet and distal lower legs. He brings with him an EMG/NCS report from last week from an outside provider. It shows a length-dependent axonal neuropathy, as well as early recruitment and low amplitude action potentials on EMG of the proximal muscles. Serum CK is obtained and 3200. Which of the following is the most likely cause of his problem?

A 26-year-old female presents with unilateral vision loss. She says that she noticed the symptoms upon awakening yesterday morning and has gotten progressively worse since then. On neurological examination, she has 20/70 visual acuity of the left eye and 20/20 of the right. There is a left afferent pupillary defect (APD). Extraocular movements are intact but cause pain. What is the most appropriate treatment?

A 38-year-old man with a prolonged history of intravenous drug use, HIV, and poor compliance with HAART therapy is brought to the hospital by police after being seen wandering across a busy street intersection. His last CD4 count was 180 cells/microliter 8 months ago. Vitals appear within normal limits on arrival. Neurological examination shows inattention, poor short-term memory, and difficulties with abstract thought. An MRI is performed and shown below. What is the likely etiology of his symptoms?

A 37-year-old female with a past medical history of obesity presented to the emergency room with a severe headache and visual disturbances. The funduscopic exam shows bilateral papilledema. An MRI of the brain shows an empty sella and MRV was normal. A lumbar puncture was performed. The opening pressure was 38 and there were no WBCs or RBCs appreciated in the CSF. What is the most appropriate therapy for her disease?

A 24-year-old male presents to the clinic with numbness in the hands and feet. He has been experiencing these symptoms since his late teens, but the numbness has gotten progressively worse. Additionally, he has been stumbling and losing his balance more frequently in the past 18 months, and he received a new pair of glasses because he was having trouble with his vision at night. On physical exam, he has decreased sensation to vibration and pinprick in his bilateral lower extremities and palpable, enlarged nerves. Laboratory studies reveal an elevated level of phytanic acid. What is the most likely diagnosis?

A 57-year-old man with a past medical history of bipolar disorder, atrial fibrillation, and type 2 diabetes presents to the clinic with complaints of a tremor. Symptoms have been present for years but they have not seemed to progress significantly over time. His current medications are warfarin, metformin, low-dose aspirin, and lithium. His neurological examination was unremarkable except for the presence of a fine, high-frequency tremor in his bilateral upper extremities. Based on the most likely diagnosis, what is the most appropriate next step in medical management?

What is the pathophysiology that leads to the pathology shown with a black arrow in the image below?

A 33-year-old woman with a past medical history of depression is brought to the clinic by her husband because of atypical behavior. For the past three weeks, her thoughts have become progressively more disorganized. She is also having auditory hallucinations. Similar behavior has been seen intermittently over the past five years. Despite having a history of depression, her husband says the depression has been well controlled for the last three months. Which of the following is the most likely diagnosis?

A 20-year-old male presents with severe burns on his hands after accidentally touching a stove. Neurology was consulted because the family noted that the patient did not initially pull away from the hot stove as one would expect. Physical exam shows decreased sensation of pain and temperature along the back and arms, with intact strength. T2 sagittal MRI of the cervical spine is shown below. Which of the following is commonly associated with the pathology shown?

A 61-year-old male with no past medical history presents to the clinic with difficulty moving for the past year. He states that it takes him a lot longer to do daily tasks such as walking to the mailbox and that it is getting worse. He is accompanied by his daughter who states that she notices that he shuffles his feet when walking. On physical exam, the patient is observed to have a 4-6 Hz resting tremor in his hand. Pathologic examination of this patient’s brain tissue would most likely show which of the following?

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?

Which of the following structures are not supplied by the posterior cerebral artery (PCA)?

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?

What is the pathophysiology that leads to the pathology shown in the image below?

A 20-year-old female presents to the clinic with weakness and numbness in the right leg. She states that earlier in the day she was taking a long nap on her right side, and when she awoke, her entire leg felt like pins and needles. When she got up, she felt that she was dragging her right leg on the floor. She has had similar experiences in other limbs over the years but symptoms would slowly improve over weeks. Nerve conduction studies showed a right common peroneal nerve conduction block and mildly decreased conduction velocities of all nerves tested. Her mother reports that her father had similar episodes before he passed away from an unrelated illness. Which of the following is the most likely diagnosis?

A healthy 12-year-old female has a brain MRI performed because of a history of medically refractory headaches. Her imaging is shown below. What is the diagnosis?

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?

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

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 72-year-old woman is brought to the clinic by her family with concerns about living at home alone. Her daughter states that the patient’s “memory is not what it used to be” and that she will often think that there are little children in her house when no one is there. On exam, you appreciate a bilateral upper extremity resting tremor. A functional PET scan will most likely show which of the following?

An 11-year-old girl has a neurosurgical resection of a brain mass. You are consulted post-op day 2 due to speech decline progressing to complete mutism. She does not have any weakness on exam. What type of tumor was most likely resected?

The pathology shown in the image below is likely secondary to which of the following?

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?

Which of the following direct dopamine agonists are the most effective in the management of severe “off” phenomenon related to chronic levodopa use in the management of advanced Parkinson’s disease?

A 67-year-old man with a past medical history of obstructive sleep apnea is being evaluated for bilateral arm tremors. His symptoms started insidiously 5 years ago. It is best appreciated when the patient brushes his teeth or eats with a fork. Oddly, he has noticed that a glass of wine at night can help with his symptoms. What is the most appropriate therapy for his movement disorder?