Quiz 07/09/2022

Carbidopa is given concurrently with levodopa to reduce the risk of which of the following side effects?

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 14-year-old female presents to the clinic with frequent falls, clumsiness, and stumbling on her feet. She also reports progressive difficulty with simple tasks such as buttoning her shirts and a loss of feeling in her feet. On physical exam, she has high-arched feet and loss of position and vibration sensation of her great toe. Thoracolumbar MRI shows atrophy of the cervical cord. This condition is associated with which genetic mutation?

Which of the following occurs at point “4” on this diagram of an action potential?

A 20-month-old female presents for regression of milestones. She was walking, and now crawls or refuses to move. The parents are concerned she may be having seizures because they notice she has intermittent jerks of the limbs and trunk, especially when she is startled. on physical exam, you note conjugate random darting of the eyes in vertical and horizontal directions. Tone, strength, and deep tendon reflexes are normal.

What test is most likely to identify the underlying etiology of this problem?

Which of the following is the mechanism of action for aducanumab?

You are asked to evaluate a patient in the neurointensive care unit who is comatose and has had a somatosensory evoked potential performed. Which of the following is most suggestive of a poor prognosis for this patient?

The combination of lamotrigine and which of the following drugs increases the risk of lamotrigine toxicity?

A 47-year-old female presents to the clinic with the chief complaint of slowly progressive proximal muscle weakness. Electromyography showed short duration, low amplitude motor unit action potentials. A muscle biopsy was performed and shown below. A diagnosis is made and the patient is started on a therapeutic agent. What is the most likely medication initiated?

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…

A patient with medically-refractory epilepsy has an MRI brain performed as part of their pre-surgical workup. Based on the imaging provided, what type of seizures is this patient most likely experiencing?

A 14-year-old male is referred to the neurology clinic by his PCP with the complaint of bilateral hearing loss. Neurological examination shows a sensorineural hearing loss. Multiple hyperpigmented lesions on the chest and back were also appreciated. An MRI of the brain was ordered that showed bilateral posterior fossa lesions. Genetic testing would reveal a mutation on which chromosome?

A 36-year-old woman presents with facial weakness. She states that symptoms started on the right side of the face one week ago, but since then the left side has also become progressively weak. Other pertinent complaints include dry cough, shortness of breath, and joint pain. MRI of the brain shows bilateral contrast enhancement of the facial nerves. Chest X-ray reveals bilateral hilar adenopathy. A diagnostic lymph node biopsy is performed. Which of the following is most likely appreciated on pathologic analysis?

A 46-year-old female presents to the clinic with complaints of recurring headaches. She states that she experiences episodes of sharp pain in her left cheek, which is exacerbated by eating or a cold wind blowing on her face. Outside of these triggers, she is largely pain-free. She doesn’t endorse any associated rhinorrhea, lacrimation, or facial flushing. Which of the following is the most appropriate treatment for her disease?

Identify the lesion shown below.

Which of the following findings is depicted in the catheter angiogram shown?

A patient with an unclear history of epilepsy has an EEG performed. Based on the region of her epileptiform activity, what is the most likely semiology of her clinical seizures?

A 37-year-old female with a past medical history of chronic fatigue and heat intolerance presents with right arm weakness. A cervical spine MRI is performed and shown below (Left: T2 sagittal. Right: T2 axial). Which of the following is the most likely diagnosis?

A 57-year-old male with HIV who is non-compliant with HAART therapy presented to the emergency room with a 4-week history of altered mental status and falls. On neurological examination, the patient was altered, ataxic, and had right upper extremity weakness. An MRI was performed and shown below. Based on the clinical presentation and imaging provided, what is the most appropriate first step in medical management?

A 65-year-old right-handed man presents with an acute onset of aphasia. CT scan of the head was normal but the MRI revealed multifocal small acute and subacute ischemic strokes in multiple vascular territories. A cerebral angiogram was performed as part of the diagnostic workup. Based on the clinical history and imaging provided what is the most likely diagnosis?

A 40-year-old woman with a history of neurofibromatosis type 2 is presenting to the clinic with chronic anosmia and progressive left eye vision loss. Visual acuity testing reveals 20/200 OS and 20/20 OD. There is a left eye afferent pupillary defect. Funduscopic examination shows pallor of the left optic disc and blurring of the disc margins of the right optic disc. An MRI brain is ordered to localize the lesion. Based on the clinical examination, where will the pathologic lesion most likely be found?

A 6-month-old full-term female is referred to the clinic with persistent right shoulder and elbow weakness since birth. Which of the following is the most likely pathologic lesion?

A 27-year-old female presented with a severe headache for the past 4 days. Last week she gave birth to a healthy baby boy. She says the pain is worse when sitting up or walking but laying down in bed provides some relief. A brain MRI with contrast is ordered which shows thickening and enhancement of the dura. What is the most appropriate therapy for this patient?

A 13-year-old male with a recent history of acute disseminated encephalomyelitis (ADEM) presents to the clinic for post-hospital follow-up. He has made a near-complete recovery from his illness but his parents want to know what is his risk of recurrence. What is the most accurate statement you can share with the parents?

A 35-year-old male presents to the neurology clinic for the management of seizures. The patient reports having focal to bilateral tonic-clonic seizures (FTBTC) since the age of 15. His seizures are usually preceded by the smell of burning rubber. He will then have left hand automatisms followed by whole-body tonic-clonic activity. Levetiracetam monotherapy was initially effective. However, 1 year ago seizures returned, occurring once every two months. Lacosamide was added 6 months ago but there has been no significant improvement in his seizure frequency. Levels of these two anti-seizure medications (ASMs) are therapeutic and there have been no concerns regarding medication adherence. What is the most appropriate next step in management?

What is the mechanism of action of phenobarbital?

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?

Paralysis of the stapedius muscle can occur with ipsilateral damage to which cranial nerve?

Identify the pattern seen in the 5th second of this EEG recording.

You are evaluating a 1-year-old who has had delayed motor development and diffuse weakness since birth and presents now to the hospital for a first-time seizure. The physical exam is notable for 3/5 deltoid abduction, 4-/5 hip abduction, 4-/5 hip flexion, and 4-/5 hip extension. He is unable to walk but is meeting cognitive milestones. An MRI brain is done and shows diffuse scattered T2 FLAIR white matter hyperintensities.

If genetic testing is performed, a mutation in which of the following genes would be most expected?

A 26-year-old female presents with unilateral vision loss. She says that she noticed symptoms upon awakening yesterday morning and it 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 likely etiology of her symptoms?

A 65-year-old man presents to the emergency room with progressive weakness over the course of several months. Examination shows pure motor weakness with no sensory involvement, decreased reflexes, and diffuse fasciculations. An EMG shows a conduction block of motor neurons outside of compression sites and normal sensory conduction velocities. Which of the following of most appropriate for treatment?

This muscle biopsy is most consistent with which myopathic disease?

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?

An 80-year-old woman with a history of well-controlled Parkinson’s disease presents with worsening movements at night. Her husband states that she often punches and yells during her sleep. Some of these movements have been so dramatic that she punched a hole in the wall beside her bed. Melatonin was tried but did not lead to a significant improvement in symptoms. Which of the following is the most appropriate next step in treatment?

Which of the following medications is associated with the occurrence of reversible cerebral vasoconstriction syndrome (RCVS)?

A 39-year-old male presents with right-sided weakness and aphasia. NIHSS is 22 on physical exam. He was last known well 2.5 hours prior. The past medical history does not reveal any contraindications to tPA. A CT head is done and shows a hyperdense left MCA sign. The tPA is mixed by the nursing staff while you consent his wife for its administration. When you return to the bedside his aphasia has improved but his NIHSS is still 13. The blood pressure is 189/105 and the glucose is 225. What is the most appropriate next step?

An 18-year-old boy had an MRI performed after experiencing a first-time seizure shown below. What genetic disorder could be the cause of the abnormalities appreciated on imaging?