Quiz 07/07/2022

A 35-year-old male with a history of intravenous drug use was found unresponsive with a used syringe at his side. After 30 minutes of CPR, there was a return of spontaneous circulation. A CTH was performed (shown below). Which of the following is appreciated on imaging?

A 38-year-old female presents to the clinic with episodes of facial pain. She reports episodes of sudden severe and debilitating sharp pain on her right face lasting a few seconds to a couple of minutes. These seem to be triggered by eating or lightly touching the face. Outside of these episodes, she is pain-free. She does not endorse any associated rhinorrhea, lacrimation, or facial flushing. What is the likely cause of her symptoms?

A 45-year-old female presents to the emergency room after experiencing a first-time seizure. On examination, she has some mild RUE weakness and anomia. MRI w/o contrast was performed and shown below. Which of the following is the likely cause of her lesion?

A 38-year-old man presents with frequent headaches over the past year and recent development of polydipsia and polyuria. He has also been complaining of a dry cough, shortness of breath, and erythematous nodules along his shins bilaterally. MRI of the brain shows a contrast-enhancing lesion of the hypothalamus. Which of the following is the most likely diagnosis?

Which of the following autoantibodies are associated with myasthenia gravis?

You are caring for a 38-year-old man with schizophrenia since his early twenties. He has had many years of uncontrollable irregular facial movements including tongue writhing, lip smacking, and frequent blinking. His psychiatrist stopped the medication suspected to cause this problem a year ago, yet he is still having the symptoms and they are especially bothersome. Which of the following medications is FDA approved for the treatment of this problem?

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?

Which of the following is the relay center for hearing?

Match the phase of the Valsalva maneuver with its associated physiology.

A 12-year-old boy with no significant past medical history is admitted to the neurology service after presenting with acute-onset fever, personality changes, and difficulties with speech. His mother states that three days ago he also reported seeing bats and other wild animals running around his room. She decided to bring him to the hospital today after she noticed that he seemed more tired and was moving slower than normal. A lumbar puncture and MRI of the brain are ordered. The CSF shows elevated protein, elevated lymphocyte and red blood cell counts, and normal glucose. MRI of the brain is shown below. What is the most likely diagnosis?

A 65-year-old right-handed man presents with acute onset speech difficulties, a mild right-sided facial droop, and right-sided arm weakness. While talking to his wife over breakfast this morning he suddenly stopped speaking and could only make unintelligible sounds. On examination, he is unable to speak any words but has intact comprehension. He is able to write clearly what he wants in full sentences with intact grammar and reading is also preserved. Which of the following best describes his language deficit?

A 66-year-old male presents to the emergency room as an unrestrained driver in a motor vehicle accident. While initially only complaining of mild neck pain, within 30 minutes of the collision he started to experience bilateral numbness in his hands and significant symmetric upper limb weakness. Soon thereafter, the weakness extended down to his lower extremities. Neurologic examination is remarkable for loss of pain and temperature sensation in his bilateral upper extremities and symmetric bilateral upper extremity greater than lower extremity weakness. Which of the following is the most likely diagnosis?

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

A 5-year-old girl is brought in by her parents because of 1 month of episodes of screaming at night. She has no recollection of these events in the mornings and she is developmentally appropriate and healthy otherwise. What is the best treatment?

Of the following, which region of the adult brain is most susceptible to hypoperfusion injury and ischemia?

An 8-year-old patient with new-onset seizures has an MRI performed after seeing you in the clinic. Based on the lesion appreciated in the image, what seizure type does this patient most likely experience?

The following is a sample of gray matter stained with Anti-NeuN and viewed under a low-power microscope lens. The pathology marked by the blue arrow is most consistent with which of the following causes of epilepsy?

A consult is placed for paroxysmal episodes in a 6-day-old male infant born at 32 weeks gestation. According to his mother, the infant seems to be shivering a lot “like he is cold”. The mother states that she has been wrapping him in warm blankets and keeping the room at a warm temperature. On physical exam, the infant is alert and interactive, without persistent focal neurological deficits. However, when touching the left arm, the patient develops a fine tremor that resolves after flexing the affected limb. Vital signs are within normal limits. Which of the following is the most likely diagnosis?

A patient with right leg weakness presents to the neuromuscular lab for electromyography. The image below depicts a spontaneous finding while evaluating the right tibialis anterior muscle. This finding is most consistent with which of the following?

Identify the structure (blue arrow) shown below:

Huntington’s disease is most commonly associated with which of the following?

Which of the following nerves when damaged can lead to scapular winging?

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

A 45-year-old man with a past medical history of cardiac arrhythmia requiring pacemaker placement is referred to the clinic with a twenty-five-year history of slowly-progressive bilateral ptosis and diplopia. On examination, he has bilateral ptosis, decreased range of motion of the extraocular muscles, and mild proximal weakness in his upper and lower extremities. Which of the following is the most likely diagnosis?

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 45-year-old male presents with left-sided neck and shoulder pain. On examination, there is right arm abduction weakness and decreased bicep and brachioradialis reflexes. An EMG was ordered and showed fibrillations of the deltoids, supraspinatus, and biceps muscles. EMG testing of the triceps, first dorsal interosseous, abductor policies brevis, and rhomboid muscles were normal. These findings are most likely due to radiculopathy of which of the following nerve roots?

Primary generalized dystonia is a genetic disorder that can be seen secondary to a mutation of which of the following genes?

A previously healthy 15-year-old male presents to the emergency room after experiencing a concussion while playing soccer. He is now back to baseline but to be thorough the ED physician orders an MRI which is shown below. What is the lesion shown in this MRI?

An otherwise healthy 17-year-old female presents to the emergency department with right arm weakness. The symptoms started insidiously over the weekend and haven’t improved over the last 3 days. Examination shows 4/5 strength of the right upper extremity. A brain MRI is performed and shows a T2 hyperintense lesion in the subcortical white matter with contrast enhancement. No other lesions are seen. Upon further questioning, she states that she has never experienced any similar episodes of transient neurologic symptoms before. Which of the following is the correct diagnosis?

A patient with end-stage amyotrophic lateralized sclerosis (ALS) presents to the emergency room from a nursing home alone. His vitals show hypoxemia and he appears tachypneic on examination. On examination, he is also paraplegic with significant weakness in the upper extremities and mild dysarthria. His mental status examination appears intact. Between short breaths, he says that he does not wish to be intubated. This is consistent with the end-of-life discussions documented in the outpatient clinic notes. As his hypoxemia worsens his wife arrives at the bedside and with urgency asks you to intubate the patient. What is the most appropriate response?

A 42-year-old woman presents to the clinic with a 2-month history of distal symmetric hand weakness that started after hospitalization for severe abdominal pain. Before this hospitalization, she was drinking alcohol with her friends when she acutely developed severe abdominal pain, nausea, restlessness, altered mental status, and hallucinations. She was noted to have dark urine at the time of admission. Since then, her GI symptoms and mentation have returned to baseline, but her weakness has persisted. On exam, she has 3/5 strength of the intrinsic muscles of the hand bilaterally. Conduction velocities of the bilateral upper extremities were unremarkable. Needle EMG revealed fibrillations and decreased recruitment of motor unit action potentials in muscles innervated by the radial and ulnar nerves. Which of the following is the most likely cause of the patient’s symptoms?

Which of the following genes is responsible for familial ALS?

A lesion to which of the following hypothalamic nuclei causes hyperphagia?

A 40-year-old man comes into the clinic with headaches. He has stabbing pain around the left temple that occurs numerous times during the day. The pain lasts 10-30 seconds at a time. He says he has excessive tearing from the left eye during these episodes. What is the most appropriate therapy?

This gross microscopic image is most consistent with which of the following diseases?

Motor unit action potential (MUAP) conduction velocities of a newborn are what percentage of an adult?

A 52-year-old woman is brought to the emergency room in respiratory distress. She is accompanied by her husband who stated that they were eating at a high-end sushi restaurant when his wife started to complain of perioral numbness and tingling. Two hours later she started to complain of generalized weakness and trouble breathing. Accidental poisoning is suspected. Based on the available information, what is the mechanism of action of the poison ingested?

A 58-year-old female with a history of atrial fibrillation on warfarin presents to the ED with aphasia and right-sided weakness. She was last seen well 2 hours prior. CT imaging is unremarkable. Which is the most appropriate next step?

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 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?