Quiz 07/13/2022 (1)

An MRI is ordered on a man with a known history of ischemic stroke and bilateral upper extremity weakness. Which of the following was the most likely cause of his ischemic injury?

A 30-year-old male presents to the emergency room with weakness in his bilateral lower extremities. On arrival, he was hypertensive and bradycardic. 2/5 strength is appreciated in his bilateral lower extremities. A loss of pinprick sensation is also appreciated from his lower extremities, but proprioception and vibratory sensation are intact. These findings are most likely secondary to a lesion of which of the following blood vessels?

A 45-year-old female with a past medical history significant for asthma presents to the clinic for migraines with aura. Her headaches occur at least 13 times a month. She was given sumatriptan for abortive therapy six months ago but it has become ineffective. Her vital signs are stable. Her BMI is 33. Which of the following is the best next step in treatment?

A 61-year-old male with a past medical history of GI cancer status post gastric resection at age 57, consequently on parenteral nutrition, presents to your clinic for a second opinion. He complains of slow movements and rigidity in his arms and legs that have slowly progressed over the last year. He denies tremors or cognitive change. He saw a different neurologist who started him on carbidopa/levodopa 6 months ago but the response has been minimal and he continues to get worse. You decide to perform a brain MRI and you see bilateral hyperintensity of the globus pallidi on the T1-weighted image. What treatment should you add?

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

A 26-year-old female presents to the hospital following a sudden onset headache and decreased responsiveness. A CT Head is obtained (left) followed by a cerebral angiogram (right). Which of the following is the most likely cause of the patient’s symptoms?

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 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 50-year-old male is admitted for 3 months of progressive memory loss, visual hallucinations, and myoclonus. Examination revealed myoclonic jerks. Which of the following tests is the most specific for this disease?

Which of the following clinical features is most suggestive of logopenic primary progressive aphasia?

A 30-year-old woman presents to the clinic with severe headaches requesting treatment because she “can’t live with this pain”. Episodes are left-sided, occur multiple times a day, and last about 20 minutes each. During episodes, she will also have eye tearing and rhinorrhea. What is the appropriate therapy?

Which of the following anti-seizure medications carries the highest risk of major congenital malformations?

A 67-year-old woman with a past medical history of osteoporosis, hypertension, bipolar disorder, and a remote right MCA stroke is referred to the epilepsy clinic after experiencing her first epileptic seizure. An EEG has shown right temporal epileptiform discharges. Which of the following medications are most appropriate to start as initial therapy?

Patients with trisomy 21 are at an increased risk for which of the following?

An EMG/NCS is performed for the evaluation of subacute left upper extremity weakness in an adult female. There are fibrillation potentials in the deltoid and biceps on EMG and decreased median and radial sensory amplitudes on NCS. Which portion of the brachial plexus was injured?

A patient with an AVM rupture is admitted to the ICU. On exam, the patient has abnormal neck, elbow, and knee extensor posturing, and wrist flexion. In which of the following locations was the AVM most likely located?

What is the typical brainstem auditory evoked response (BAER) finding with cortical hearing loss?

A 34-year-old woman comes to the emergency room with complaints of neck stiffness, headaches that are worse on standing, and diplopia. An MRI brain with contrast shows diffuse dural enhancement. Which of the following findings is also likely to be present in this case?

Where is the anatomic origin of the normal EEG sleep structure seen in the 3rd second of this recording?

A 6-year-old Amish female presents to the emergency department with a 2-month history of gradual cognitive decline and jerking limb movements. A routine EEG was obtained (see below). Which of the following diseases is consistent with these EEG findings?