Quiz 07/10/2022 (1)

A 58-year-old woman presents with worsening memory loss and a 50-pound weight gain over the past six months. On neurological exam, her Mini-Mental Status Examination (MMSE) yields a score of 21/30. She has intact sensation, normal muscle bulk, tone, and strength, but diffuse hyporeflexia. Which of the following is most likely the diagnosis?

Identify the lesion shown in the image below.

A 2 month-old female is brought to the emergency room by her mother after she noticed abnormal movements concerning for possible seizure. The child was born at term and was the product of a normal pregnancy and delivery. While gathering a history, the child is lying on the bed still when you notice repetitive movements of his bilateral lower limbs. When her mother notices she picks up the patient and the movements resolve. What is the most likely diagnosis?

A 42-year-old man with a 6-month history of progressive muscle weakness has a nerve biopsy performed. Based on the toluidine blue (left) and trichrome (right) stain slides shown, which of the following is the most likely diagnosis?

A 47-year-old man with a history of bilateral cataract surgery at the age of 20 presents to the clinic for evaluation of progressive unsteadiness and cognitive decline. His father and older brother reportedly had similar symptoms in their early adulthood as well. On exam, there is notable dysmetria and gait ataxia. There were also abnormal soft-tissue masses appreciated near the Achilles tendons bilaterally. Which of the following is most likely to be abnormal in this patient blood?

A 49-year-old woman with recurrent episodes of vertigo and has an MRI brain performed at the request of her neurologist. Imaging reveals a well-circumscribed dural-based homogenous contrast-enhancing lesion. What is the most likely etiology of the lesion outlined above?

A 56-year-old man with a past medical history of hypertension and type II diabetes presents to the hospital with acute onset left-sided weakness which started 90 minutes prior to your evaluation. His only medications prior to admission were metformin and verapamil. Vitals were within normal limits except for a blood pressure of 154/92. Physical examination reveals 3/5 weakness in the left arm, leg, and face as well as a moderate sensory disturbance in the same regions. CT head was unremarkable and CT angiogram (CTA) showed no large vessel occlusion. A brief history gathered from his wife revealed no other comorbidities or active medical issues. At this point in his clinical presentation, what is the mechanism of action of the most appropriate therapy?

A morbidly obese patient with a past medical history of brainstem stroke and excessive daytime sleepiness undergoes polysomnography. Polysomnographic testing revealed an average of 8-10 apnea/hypopneas per hour during sleep. During prolonged periods of apnea, there were no out-of-phase movements on plethysmography. Which of the following is the most likely diagnosis?

Of the following, which extraocular muscle is not innervated by the oculomotor nerve?

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?

What sensitivity should the EEG be at to qualify for brain death criteria?

A 40-year-old male is referred to the clinic for a one-year history of progressive weakness of the upper and lower extremities. Past medical history is impressive for thrombocytopenia, anemia, and hepatosplenomegaly. Neurological examination shows 2/5 strength in the distal lower limbs bilaterally with diminished ankle and patellar reflexes. The sensory exam shows diminished vibratory and pinprick sensation in both legs. He also has a markedly orange discoloration of his tonsils. Genetic testing is performed which reveals a mutation in the ABCA1 gene. Which of the following is the most likely diagnosis?

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 32-year-old male with a longstanding history of epilepsy secondary to mesial temporal sclerosis returns to your clinic. Despite being on appropriate doses of levetiracetam and valproic acid he continues to have 20 partial seizures and 4 generalized tonic-clonic seizures per month. Which of the following is the next best step in his care?

A 20-year-old male presents to your clinic for weakness. He is the star baseball player at the local university, but during the season his batting average has been dropping, and he finds he is having trouble standing on his toes, performing overhead shoulder presses, and more recently ascending steps. You give him a script for some blood testing and an EMG/NCS and schedule a follow-up in 2 weeks.

Unfortunately, shortly after returning home he had a fall down a flight of stairs and sustained a compound radius fracture. He was taken to the emergency room where an open reduction and fixation (ORIF) was performed. Shortly after the surgery, he developed tachycardia, tachypnea, and masseter muscle contractions, which then progressed to fever and rigidity.

Which of the following test results is most likely to be seen in this patient?