Quiz 07/06/2022

Neural tube defects will develop at which point in fetal development?

The PET scan shown is most consistent with which of the following diseases?

EMG abnormalities in which of the following muscles can not localize to the brachial plexus?

A 60-year-old woman with a history of diabetes is presenting to the neurology clinic with a 4-month history of burning/tingling in her bilateral toes. Neurological examination revealed 5/5 strength in all muscle groups, normal reflexes, and intact sensation to light touch in the bilateral lower extremities. There was mildly decreased sensation to pinprick in the 1^st toe bilaterally. Which of the following tests is the most likely to be diagnostic for this patient?

You are consulted to the psychiatric hospital to see a 48-year-old female with schizophrenia who has been under psychiatric care for 2 weeks after ingesting hundreds of pennies over a prolonged period. You are asked to address her new complaints of numbness in her feet and trouble walking. On exam, she had a broad-based gait and a positive Romberg. What could explain these findings?

A 14-year-old male is evaluated in your clinic for seizures. Past medical history is significant for brief staring spells in elementary school. Now the patient is having generalized seizures especially when he is sleep-deprived. Additionally, the patient has recently been experiencing jerky movements of both arms in the morning, resulting in him dropping objects from his hands. An EEG shows generalized 4-6 Hz polyspike and wave discharges. What is the most likely diagnosis?

An MRA is ordered for a patient presenting with an acute stroke. Based on the lesion appreciated in the image below (white arrow), what symptom is likely to be seen on examination?

A 24-year-old healthy male with recent right-sided otitis media complicated by mastoiditis presents to the ER with a first-time seizure. On examination the patient is somnolent and febrile, MRI brain shows a right temporal lobe intraparenchymal mass with a solid rim of contrast enhancement and surrounding vasogenic edema, what is the most likely etiology?

A 65-year-old female with 40 pack-year history presents with a 2-week history of generalized weakness that improves with repeated testing. You are concerned for Lambert-Eaton myasthenic syndrome (LEMS). Which of the following statements is incorrect regarding LEMS and/or myasthenia gravis (MG)?

Identify the lesion below.

A patient with a history of low back pain had an MRI of their lumbar spine completed as part of their workup. The T2 FLAIR image of the lumbar spine MRI is shown below. What is the most likely diagnosis?

Which of the following medications can potentially reduce the platelet inhibition of clopidogrel?

An overweight 54-year-old male presents to the neurology clinic with excessive daytime sleepiness. His wife states that the patient snores excessively during sleep. Which of the following is the most appropriate diagnostic test?

Which of the following is most likely to cause the pathology seen in the image below (white arrow)?

Which of the following is the correct order of venous structures related to cerebral blood drainage?

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

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 42-week gestational age female was born vaginally to a mother with a history of type 2 diabetes. Delivery was complicated by shoulder dystocia and required assistance with forceps. Apgar scores at 1 and 5 minutes were seven and nine, respectively. Her birth weight was 9 pounds and 6 ounces. Examination after birth showed there was no appreciable left arm bicep or deltoid function. What is the most likely etiology for this finding?

Cool limbs during a nerve conduction study will have which of the following effects on the data recorded?

What is the mechanism of action of pregabalin?

A 30-year-old woman has visual evoked potentials performed that show a right eye P100 latency of 140 msec and a left eye P100 latency of 103 msec. Which of the following is the most likely cause?

Which of the following can not passively diffuse across the blood-brain barrier?

You are evaluating a patient in the clinic for loss of light touch, pain, and body position in the left upper and lower limbs. Within which of the following thalamic nuclei do these signals synapse to third-order neurons?

Which of the following conditions is most likely to have an associated disorder of abnormal motor activity during the following sleep state?

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 24-year-old woman presents to the ER with a one-day history of diplopia. On examination, the patient has right internuclear ophthalmoplegia. On further discussion, she describes an episode of left lower extremity numbness about 2 years ago that resolved after a few weeks on its own. An MRI of her brain and spinal cord was ordered. Findings included a T2 hyperintense contrast-enhancing lesion in the pons, as well as non-contrast enhancing T2 hyperintense lesions in periventricular and juxtacortical regions as well as in the thoracic spinal cord. What is the next step to confirm her diagnosis?

A previously healthy two-year-old girl is brought to the clinic by her parents due to a 1-month history of difficulty walking. Her parents state that she began walking at 11 months old, but over the past month she has been falling more often. On physical exam, the patient demonstrates a broad-based gait and truncal ataxia. A CT scan of the brain is ordered and shows an intraparenchymal hyperdense mass in the cerebellum. She undergoes resection of the mass and a pathologic examination of the specimen shows anaplastic small round blue cells. What is the most likely diagnosis?

A 34-year-old woman comes to the emergency room with complaints of neck stiffness, headaches that are worse on standing, and diplopia. An MRI brain with contrast shows diffuse dural enhancement. Which of the following findings is also likely to be present in this case?

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?

Based on the findings on the muscle biopsy (trichrome stain) shown below, which of the following is most likely seen on examination of this patient?

A 30-year-old man with a past medical history of migraines presents to the emergency department for his typical migraine symptoms, which have become intractable. He is treated with a “migraine cocktail” (normal saline, acetaminophen, and prochlorperazine) with some improvement. You are then called to the bedside for concern that he is having a possible seizure. His head is turned forcibly to the right without eye deviation and he is able to follow commands and verbalize. Which of the following is the best next step in management?

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

A 67-year-old male with a past medical history of hypertension and diabetes presents with a 5-day history of facial paralysis and an ear rash. The patient states he returned from a 4-day backpacking trip in the Adirondacks 2 weeks ago in upstate New York where he engaged in hiking and freshwater swimming. His temperature is 36.9 °C (98.5°F), pulse is 72/min, and blood pressure is 131/78. Examination reveals an erythematous vesicular rash in the left auditory canal and pinna and drooping of the left face, forehead, and eyelid. A Weber test lateralizes to the right ear and a Rinne test shows air conduction greater than bone conduction in both ears. What is the most likely diagnosis?

A 17-year-old woman with no significant past medical history except for an upper respiratory tract infection 2 weeks ago presents with a one-day history of fever, headache, and altered mental status. On examination, the patient also had right-sided ataxia. An MRI brain was ordered and T2 sequence images are shown below. The lesions showed minimal lesional enhancement with contrast administration (image not shown). What is the most likely diagnosis?

Which of the following statements regarding Alexander’s disease is incorrect?

Which synapsed of the peripheral nervous system is acetylcholine the primary neurotransmitter?

Which of the following is an absolute contraindication for the use of tPA?

A 19-year-old male was admitted to the hospital with a 2 weeks history of progressive lower extremity weakness. CSF studies showed an elevated CSF protein and normal WBC count. MRI of the lumbar spine showed contrast enhancement of the cauda equina. His nerve conduction study (NCS) is shown below. What is the most appropriate next step in medical management?

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 7-year-old boy with no significant past medical history presents to the clinic after declining school performance and daydreaming. A routine EEG is performed and shown below (bipolar montage). Which of the following medications is the most appropriate first-line therapy?