Quiz 07/10/2022

A 38-year-old man with a past medical history of HIV, depression, and asthma presents after experiencing a first-time seizure. He was last seen normal about 45 minutes ago by his husband, who witnessed him seizing for about 10 minutes. A CTH is performed and normal. A lumbar puncture is performed and reveals the findings below. Which of the following is the most likely cause of the patient’s symptoms?

A 31-year-old female who recently delivered a healthy boy 3 days ago comes into the emergency room with a headache and vomiting. Other than requiring an epidural for pain management, the delivery of her child was uncomplicated. Her neurological exam is normal. A brain MRI was completed and is shown below (Left: T1, Right: T2 with contrast). Which of the following is the most likely diagnosis?

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

Which of the following identifies the sigmoid sinus?

A 55-year-old female with a past medical history of coronary artery disease and ischemic stroke with residual mild left arm weakness presents with headaches for a year. Episodes occur two to three times a month. The pain is unilateral and is associated with nausea and photophobia. During this episode, she is unable to go to work and over-the-counter anti-inflammatories have been ineffective. Physical exam and vitals are normal. Which abortive therapy is the most appropriate next step in management?

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 38-year-old woman with a history of gastric bypass begins taking over-the-counter supplements that are intended to promote hair and nail health. After several months, she begins to experience paresthesias in her legs and has several falls. She is referred to a neurologist. On examination, she is noted to have non-length-dependent severe loss of vibration sensation in her legs, loss of pain and temperature distally in a length-dependent pattern, and spastic tone with hyperreflexia in her lower extremities. Additionally, her gait is wide-based and a Romberg’s sign is positive. Which of the following treatments is most likely to prevent further neurologic deterioration?

A healthy 12-year-old female has a brain MRI performed because of a history of medically refractory headaches. Her imaging is shown below. What is the diagnosis?

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 two-week-old, full-term female with an uncomplicated delivery is brought to the clinic with abnormal jerky movements. Her father states that episodes occur right after the patient is put down for a nap, last for roughly 3 minutes, and resolve with arousal. During the episodes, the patient has rapid, repetitive myoclonic movements of her upper limbs. The physical exam is unremarkable. The patient was admitted to the Epilepsy Monitoring Unit where a typical event was captured and had no EEG correlate. Which of the following is the most likely diagnosis?

A 43-year-old female presents with rapidly declining cognitive function over the past few weeks. She is no longer able to hold a sustained conversation, she is no longer able to drive, and has worsening insomnia. CSF analysis shows increased 14-3-3 protein levels. What is the pathogenesis of this patient’s disease?

The medulla develops from which of the five primary vesicles of the brain?

Paraphasic and semantic errors in speech can occur secondary to a lesion in which of the following regions?

A 75-year-old patient is brought in by her husband because of word-finding difficulty.  On cognitive testing, the most impressive finding was that the patient could not recall many colors of the rainbow. Based on this finding, what kind of memory is most impaired?

An abnormal breathing pattern described as irregular inspiratory phases and variable intervals of apnea can localize to damage to which of the following regions along the neuraxis?

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?

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 72-year-old man with a history of right-sided carotid stenosis was transferred from an outside hospital to your institution to have a carotid stent placed after experiencing a mild right-hemispheric ischemic stroke. The patient was sent to the angiography lab and had a carotid stent placed, however, it was done so on the unaffected (left) side. What is this an example of?

Which of the following is the most likely cause for the gross pathology shown in the image below?

A 75-year-old man with hypertension and diabetes presents to the emergency department with a sudden onset of loss of sensation in the buttocks, perineum, and inner surfaces of both thighs, and urinary and fecal incontinence. On physical exam, he has loss of pain and light touch in the area described, as well as a loss of sphincter tone, and hyperreflexia in the lower extremities. Strength is mildly decreased in the distal lower extremities, without atrophy. What structure is most likely injured?