Quiz 07/06/2022

Neimann-Pick disease occurs due to a mutation of which of the following enzymes?

A 47-year-old former football player with a history of diabetes and hypertension presents to the EMG lab with left upper extremity weakness and pain. Motor and sensory nerve conduction studies were normal. An EMG was performed and shown below. 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?

A 65-year-old man with a past medical history of chronic liver disease and diabetes presents with progressive falls and a tremor. On exam, he is rigid throughout with significant gait instability, a tendency to turn his head to the right, and a hypertrophied left sternocleidomastoid muscle. He fails initial treatment with carbidopa-levodopa. His brain MRI reveals T1 hyperintensities of the bilateral globi pallidi. Which of the following is the most likely diagnosis?

A patient with a history of focal to bilateral tonic-clonic seizures has an EEG performed to see if they have responded to levetiracetam. Based on the EEG below, from which region of the brain does epileptiform activity arise?

A 35-year-old man developed a right clavicle fracture after an accidental fall from a ladder while hanging Christmas lights. He was treated conservatively with a figure-of-eight bandage and sling. He presents to your clinic 2 weeks after the accident. He states ever since the accident he has had right arm and shoulder pain, as well as numbness extending from his triceps to his middle dorsal aspect of the forearm, wrist, and dorsal aspect of digits 1,2 and 3. On examination, his strength is 5/5 throughout all extremities except 4/5 to abduction of the deltoid, extension of the triceps, and wrist extension.

Which nerve or cord, if injured by the clavicle fracture, would explain his symptoms?

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

A mutation in which of the following genes would be most likely in a patient with numerous cavernous malformations seen on head imaging?

A 5-year-old female was brought to the neurology clinic for a second opinion for paroxysmal spells of dizziness. The family states that several times a month the patient will develop severe dizziness, nausea, and vomiting. Symptoms usually only last less than 5 minutes. An MRI and 24-hour ambulatory EEG have been performed in the last 3 months. Both were unremarkable. What is the most likely diagnosis?

Axial T2 (left) and T1 (right) brain MRI images of a 3-month-old with a history of seizures and developmental delay are displayed below. Which of the following is the most likely cause for the pathology shown?

A 19-year-old female who was admitted to the epilepsy monitoring unit for medically refractory epilepsy had one of her typical seizures captured during recording (see below). Which of the following symptoms did the patient most likely experience at the time of this recording?

A 55-year-old was recently diagnosed with breast cancer. She required a right mastectomy, lymph node resection, and local radiation. She presents to your clinic with right arm pain and weakness. On exam, she has weakness only to forearm pronation, and flexion at the wrist and biceps. She also has numbness of the lateral hand and the first 3 digits.

Which cord or nerve was likely injured from the surgery or radiation?

Which of the following is the genetic mutation commonly seen in patients with hereditary neuropathy with liability to pressure palsy (HNPP)?

A 13-year-old boy presents with worsening severe headaches, nausea, vomiting, sleepiness, and confusion. The symptoms have been episodic, improved somewhat by lying recumbent. An MRI is done and shows the following. Which of the following is the best treatment option?

A 54-year-old male with hypertension, hyperlipidemia, and atrial fibrillation on warfarin is newly diagnosed with epilepsy. Of the following medications, which is the most appropriate anti-seizure medication to prescribe?