Quiz 07/14/2022

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 mother and father bring in their 8-month-old son to your clinic for clinical events described as sudden flexion of the limbs and trunk, seen most often upon awakening or falling asleep. His interictal EEG is demonstrated below. Which of the following is the most likely cause of the patient’s symptoms and EEG findings?

A 42-year-old female with a history of epilepsy has an EEG performed while establishing care with a new provider. She admits to knowing very little about what type of epilepsy she has. A 10-second epoch of her study is shown below. Based on the available data, what medication should be avoided in the management of her epilepsy?

A 62-year-old male with a past medical history of hypertension, type 2 diabetes, and dyslipidemia presents with a stepwise progression of worsening forgetfulness over the last three years. Physical examination reveals a score of 20/30 on the Mini-Mental State Examination with deficits in multiple cognitive domains. Hyperreflexia in the left upper and lower extremities is also appreciated. Her axial FLAIR sequence brain MRI scan is shown. Which of the following is the most likely diagnosis?

A patient with a history of focal to bilateral tonic-clonic seizures has an EEG performed to see if they have responded to levetiracetam. Based on the EEG below, from which region of the brain does epileptiform activity arise?

A 9-year-old boy presents with his mother for 18 months of multiple complaints. He reports having continuous thoughts of needing to wash his hands and building anxiety until he can perform the action. He spends more than an hour in total every day washing his hands. He also has stereotyped movements on exam with head turning and shoulder shrug, and will sometimes shout random words. Lab and imaging workup is negative. Which of the following medications, paired with cognitive behavioral therapy, is most indicated?

A 45-year-old female who is a professional pianist was referred to the EMG lab for right-hand numbness and tingling. Based on the EMG data outlined below where is this patient’s pathological lesion?

Which of the following is most likely to be damaged by carbon monoxide toxicity?

An 85-year-old woman presents to the hospital with an acute onset of language impairment. On examination, she has difficulty with comprehension but her verbal fluency and repetition are normal. Which of the following best describes her deficits?

A 5-year-old girl is brought in by her parents because of 1 month of episodes of screaming at night. She has no recollection of these events in the mornings and she is developmentally appropriate and healthy otherwise. What is the best treatment?

A 50-year-old female presents with altered mental status. Her family states that over the past couple of weeks, the patient has had progressive memory loss, mood changes, and poor judgment. On examination, the patient has involuntary arm movements and an exaggerated startle response. Brain MRI, DWI sequence, is shown below. Which of the following is the most likely diagnosis?

What task is likely being performed during this EEG recording?

A 38-year-old man with long-standing migraines was recently hospitalized for an unprovoked seizure. Upon further questioning, the patient admits to a strong family history of headaches and early strokes. A brain MRI is completed and a T2 sequence image is shown below. This patient likely has a mutation in which of the following genes?

A 50-year-old Caucasian woman with no past medical history is admitted to the psychiatric hospital after trying to jump from a moving bus. She reports the other passengers were laughing at her in their minds, and trying to steal her thoughts. Upon arrival to the psychiatric floor, she is witnessed to have sudden left eye deviation with right arm twitching for a few seconds before turning her head, screaming loudly, and falling to the floor with full-body convulsions, lasting 2 minutes.

You, the attending neurologist, are consulted to help evaluate. On exam she is easily distractible, looking to the corners of the room for security cameras. You contact her husband who states she has never had any problems like this before, but she has gone downhill over the last 3 weeks, forgetting people and places, repeating herself, and acting strangely.

Lab evaluation reveals normal CBC, BMP, TSH, T4, free T4, and T3. The comprehensive drug screen is negative. MRI brain w/ and w/o contrast is normal appearing. Lumbar puncture is with 18 cmH20 opening pressure, 0 WBCs, 1 RBC, 50 protein, and 55 glucose. The autoimmune panel is sent and anti-microsomal antibodies are elevated. What is the most likely diagnosis at this time?

Which of the following is the most common cause of focal clonic seizures in full-term neonates?