Quiz 07/14/2022

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 72-year-old patient presents to the clinic with an 8-month history of progressive difficulty using his right arm and falls. On exam, there is right arm rigidity, bradykinesia, and intermittent myoclonus. Romberg testing was positive. Extraocular eye movements and memory testing are normal. Which of the following is the most likely diagnosis?

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

A 90-year-old woman presents to the emergency room with an acute change in mental status. On examination, she is alert but is not answering questions or following commands. Speech is fluent, but not interpretable. Comprehension is severely impaired. Interestingly she was able to repeat full sentences without much difficulty. Which of the following is the most likely territory of ischemic damage?

Which of the following genes is responsible for familial ALS?

A 38-year-old man visiting from India presents to your clinic as a new patient for months of weakness in bilateral ankles to dorsiflexion and plantar flexion. On exam, he has diminished reflexes. He had an EMG done recently, showing axonal neuropathy in the lower extremities. He does not have his medication list with him, but he states he has taken a medication prescribed in India for “a cough” for several months. Which of the following labs would provide the highest yield?

Which of the following findings is most typically seen with HIV-associated neurocognitive disorder?

A 7-year-old male with a history of multiple febrile seizures has recently presented repeatedly with new recurrent non-febrile clonic seizures. Which of the following gene mutations is associated with this epilepsy syndrome?

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?

Which of the following muscles is innervated by the vagus nerve (CN X)?

An 8-year-old girl presents with a progressive neurologic disorder. She initially was noted to have slow learning and clumsiness years ago. Shortly thereafter she developed a seizure disorder of unclear etiology. Now, she has been having progressive visual changes and worsened cognition and memory. To aid in the diagnosis, a muscle biopsy is done and shows autofluorescent curvilinear bodies. Her disorder falls into which category of disease?

An 8-year-old girl is noted to have staring spells during class by her teacher. In the office, you are able to provoke an event by having her blow repeatedly into a pinwheel. What is the most likely underlying pathology of her disease?

A 37-year-old female with a past medical history of chronic fatigue and heat intolerance presents with right arm weakness. A cervical spine MRI is performed and shown below (Left: T2 sagittal. Right: T2 axial). Which of the following is the most likely diagnosis?

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

A patient with a clinical history concerning for hydrocephalus has an MRI brain completed (see below). Surgical resection was completed and genetic analysis revealed no presence of an IDH mutation or 1p/19q co-deletion. What is the most likely diagnosis?

A 68-year-old female presents with a one-year history of progressive memory problems and deteriorating mobility. Upon further questioning the patient notes incontinence. A physical exam reveals a wide-based gait with shuffling steps. A brain MRI shows widening of the temporal horns of the lateral ventricles. Which of the following is the best next step in management?

The brain MRI (susceptibility-weighted imaging) shown below is most likely associated with which of the following conditions?

A 37-year-old retired nurse is being evaluated in the emergency room for excessive diarrhea. She has been in the emergency department multiple times in the past for similar complaints and diagnostic testing has repeatedly been unremarkable. While casually talking to the nursing staff, the patient accidentally knocks over her purse and several bottles of laxatives fall out. Which of the following is the most likely diagnosis?

A 32-year-old female presents to the emergency room after a motor vehicle accident as a restrained back seat passenger. Her only complaint on arrival is back pain. She has bruises across her abdomen and chest and a normal neurological exam. Thoracic spine imaging was completed and is shown below. Which of the following is the most likely diagnosis?

The anatomical structure identified in the image below (blue arrow) derives from which of the following embryonic tissues?