Quiz 07/11/2022

A four-year-old boy with no significant past medical history is brought to your clinic due to difficulty walking. His mother states that he began walking at 12 months of age, but in the past few months, he seems to be more fatigued and weak when walking. On physical exam, his calves seem to be abnormally large. This disorder is caused by what mutation?

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 28-year-old caucasian male was last seen well at 9:00 AM when he got into a verbal argument with his girlfriend. When the girlfriend returned from work at 5:00 PM, she found the patient on the floor of the garage altered, and states he “smelled unusual”. In the emergency department, the patient is disoriented but arousable with much effort. He complains of a headache and blurred vision, and he appears uncomfortable with a respiratory rate of 40. You send stat labs and they are listed below. What treatment should you administer immediately?

ABG: 7.18 pH, PCO2 = 28, PO2 = 118
Electrolytes: Na 135 mEq/L, K 5.0 mEq/L, Cl 105 mEq/L, HCO3 15 mEq/L

Which way are the patient’s eyes moving at the point of the asterisk marked below?

Which of the following medications is approved only for moderate to severe Alzheimer’s Disease?

Which of the following structures are not supplied by the posterior cerebral artery (PCA)?

A 4-day-old full-term baby is brought to the hospital for two episodes of generalized stiffening and apnea for less than 1 minute followed by a return to baseline. The physical exam is unremarkable and CTH is negative. The mother reports having similar episodes shortly after birth. What is the most likely cause of the episodes?

Which is the following findings on EMG is suggestive of a chronic neurogenic lesion?

Which of the following has the longest half-life?

Immunohistochemical staining with GFAP is particularly useful in identifying which of the following cell types?

A 26-year-old female presents with unilateral vision loss. She says that she noticed the symptoms upon awakening yesterday morning and 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 appropriate treatment?

A 22-year-old woman with a previously diagnosed history of prior suicide attempts, EEG-confirmed epilepsy, and non-epileptic seizures comes to your clinic to establish herself as a new patient under your care. Upon entering the room she immediately tells you about her horrible relationship with her last epileptologist and how abandoned she felt when he decided to retire. While gathering her social history, she endorses a history of excessive spending on new cars, reckless driving, and alcohol-driven physical altercations. Which of the following personality disorders is most consistent with this clinical presentation?

Which of the following is the mechanism of action of memantine?

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 10-year-old girl is brought to the clinic with a 1-month history of progressive clumsiness. Neurological examination shows significant bilateral ataxia. Imaging was performed and showed a midline lesion in the 4^th ventricle. A biopsy was performed and shown below. Based on the most likely diagnosis, what is the most appropriate treatment plan?