Quiz 07/11/2022 (4)

A 19-year-old male presents to the ED during finals week of college after he had witnessed generalized convulsive activity on the floor of his dorm room. He has since returned to baseline. He states he has never had shaking like this before, other than when he wakes in the morning he’ll get an occasional twitch or two. An EEG is performed as below. Which is the treatment of choice?

A 34-year-old female presents to the clinic with the chief complaint of headaches. She endorses a unilateral, throbbing headache that occurs up to 8 times a month. Episodes can last between 1-3 hours. She admits to nausea and photophobia during her headaches. What is the most likely diagnosis?

A 30-year-old female presents to the ER with a three-day history of progressive weakness, double vision, and slurred speech. The first symptoms appreciated were double vision and slurred speech, followed by weakness in the upper extremities. Symptoms then descended to involve the lower extremities. On examination, the patient had decreased tone, areflexia, mydriasis, and restricted extraocular movements bilaterally. A neuromuscular junction disorder is suspected. Based on the most likely diagnosis, which of the following would be seen in this patient’s neurodiagnostic testing?

An 83-year-old male with a past medical history of PD is brought to the clinic with his daughter due to worsening behavior at his nursing home. He has become easily agitated with staff and will occasionally yell out at night at “people trying to rob him”. His daughter asks which treatments could be used to help with these symptoms. Which of the following antipsychotic agents would be the best treatment options?

A 45-year-old man comes into the ED complaining of a severe headache. A spinal tap shows xanthochromia. The patient is treated immediately and spends the next two weeks in the neurocritical care unit. On day nine of his stay, his speech becomes slurred and the neurologist notices that the left side of his face is drooping. What is the class of drugs that could have potentially prevented these findings?

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 previously healthy 14-year-old female presents to the emergency room after experiencing a trip and fall where she hit her head. She returns to baseline, but out of caution a CT head and subsequent MRI brain are performed in the ED. What is a potential complication caused by this lesion seen in this MRI?

Which of the following is classically seen on electromyography in a patient with a chronic neuronal injury?

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 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?

Which of the following antiplatelet medications rely heavily on the cytochrome P450 system for its therapeutic effect?

The lesion shown below is most consistent with which of the following pathologies?

Which of the following medications has been shown to improve neurological outcomes in patients with subarachnoid hemorrhage?

Which of the following is the most likely diagnosis based on the EMG provided below?

This muscle biopsy is most consistent with which myopathic disease?