Quiz 07/15/2022

A 68-year-old male presents with complaints of insomnia for 2 years. On further questioning, he also endorses a 2 years period of feelings of guilt about his sleeping, considerably low appetite (current BMI = 17), and low energy. He used to enjoy checkers but has lost interest in most activities these days. He denies suicidal ideation. He has previously declined medications to help with this, but he says he is ready to try something. Which of the following medications is most appropriate?

A 19-year-old female who was admitted to the epilepsy monitoring unit for medically refractory epilepsy had one of her typical seizures captured during recording (see below). Which of the following symptoms did the patient most likely experience at the time of this recording?

You are caring for a 38-year-old man with schizophrenia since his early twenties. He has had many years of uncontrollable irregular facial movements including tongue writhing, lip smacking, and frequent blinking. His psychiatrist stopped the medication suspected to cause this problem a year ago, yet he is still having the symptoms and they are especially bothersome. Which of the following medications is FDA approved for the treatment of this problem?

A 56-year-old woman with a history of right temporal epilepsy with no other comorbidities had an ambulatory 24-hour EEG performed. What is the state of the patient in this segment of the recording?

A 40-year-old male presents with a one-day history of numbness of his right arm. This has never happened before, but he does report an episode of left leg weakness that self-resolved two years ago. The neurological examination confirms a sensory disturbance of his right arm. Sagittal MRI of the cervical spine is shown below (Left: T1, Middle: T1 with contrast, Right: T2). Which of the following is the most likely diagnosis?

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 is most strongly associated with an increased risk of seizure recurrence after a first unprovoked seizure?

The trochlear nucleus sends nerve fibers to which of the following muscles?

Which of the following cranial nerve(s) transverses through the structure (blue arrow) shown below?

A 12-year-old boy with a past medical history of sickle cell disease was admitted to the emergency room in a pain crisis. While being treated with morphine the patient developed acute left arm/leg weakness and numbness. Which of the following is the most likely etiology for the patient’s new neurologic symptoms?

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?

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

A 48-year-old male with a history of a motor vehicle accident and right leg tibial plateau fracture was referred to a neurologist because of right leg weakness. He states he often catches his right foot while walking and stubs his toes when he walks barefoot. On examination, there is decreased ankle dorsiflexion and eversion of the foot. Weakness of which of the following muscles is responsible for the patient’s symptoms?

A 65-year-old male is referred to the EMG lab with a recent right leg injury and associated weakness. Based on the EMG shown below, where is the most likely site of neuronal injury?

A healthy 12-year-old female has a brain MRI performed because of a history of medically refractory headaches. Her imaging is shown below. What is the diagnosis?

A 47-year-old woman from the Caribbean presents to the clinic with a seven-year history of progressive difficulty with ambulation. The exam is notable for lower extremity spasticity. An MRI is ordered and shows atrophy of the spinal cord without other changes. The clinical and MRI findings for this patient are most likely secondary to which of the following infections?

A 38-year-old woman with a history of gastric bypass begins taking over-the-counter supplements that are intended to promote hair and nail health. After several months, she begins to experience paresthesias in her legs and has several falls. She is referred to a neurologist. On examination, she is noted to have non-length-dependent severe loss of vibration sensation in her legs, loss of pain and temperature distally in a length-dependent pattern, and spastic tone with hyperreflexia in her lower extremities. Additionally, her gait is wide-based and a Romberg’s sign is positive. Which of the following treatments is most likely to prevent further neurologic deterioration?

Which synapsed of the peripheral nervous system is acetylcholine the primary neurotransmitter?

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

A 15-year-old male is brought to his primary care doctor by his parents because of learning difficulties in school. Examination revealed several pigmented skin lesions (see below). Which of the following additional findings may be present on examination?

Which of the following genetic disorders is most commonly associated with holoprosencephaly?

What is the mechanism of action of apixaban?

While on the consult service you are called to see a patient from the surgical ICU whose hospital course has been complicated by a prolonged episode of ventricular tachycardia and hypoperfusion. After a return to spontaneous circulation, an MRI is performed due to concerns for ischemic stroke. MRI shows bilateral parietal-occipital hyperintensities on diffusion-weighted imaging consistent with watershed infarcts. Once he recovers from his cardiac event, what neurologic symptoms would you expect based on the MRI findings?

Carbidopa is given concurrently with levodopa to reduce the risk of which of the following side effects?

Which of the following structures is not primarily involved in the processing and relay of auditory information in the central nervous system?

Aquaporin-4 (AQP4) channels are found on which cell type?

Which of the following arteries provides the prominent supply to the posterior limb of the internal capsule?

A 34-year-old man was admitted to the hospital and intubated after a severe motor vehicle accident leading to multiple bone fractures two days ago. Despite weaning IV sedation, the patient continues to be unarousable to stimulation. An MRI was performed and DWI imaging is shown below. What is the most likely diagnosis?

You have recently diagnosed an asymptomatic 45-year-old man with Huntington’s disease based on genetic testing which was requested based on a family history of the disease. The patient was informed of these findings in the clinic with his wife by his side. On the following day, you receive a phone call from the patient’s 23-year-old son asking what the results of the testing were. What is the most appropriate response to this question?

Which of the following is the most accurate statement regarding driving with epilepsy?

Which of the following nerve conduction study abnormalities is least likely to be seen during the initial phase of acute inflammatory demyelinating polyneuropathy (AIDP)?

Which of the following identifies the vein of Galen?

An MRA is ordered for a patient presenting with an acute stroke. Based on the lesion appreciated in the image below (white arrow), what symptom is likely to be seen on examination?

A 19-year-old college student presents with an inability to look up at the board in class. On exam, he has upward paralysis but with preserved downward gaze. Pupillary accommodation is normal, but they remain dilated with the light shining. Where is the most likely location of the lesion?

A 56-year-old male presents with unusual behavior of compulsive eating and inappropriate sexual gestures. On exam, the patient has difficulty keeping his hands to himself and is distracted by the objects in his bed. A lesion in which area(s) of the brain would explain this syndrome?

Oculomotor nerve palsy is most likely to be seen secondary to an aneurysm in which of the following arteries?

A 57-year-old male presents to the Emergency Room with a 3-month history of progressive altered mental status. On examination, the patient had ataxia and hyperekplexia. An MRI is performed and shown below. What is the most likely etiology of the patient’s deficits?

A patient presents with sudden-onset gait instability and dysphagia. On exam, he has dysmetria of the right hand, anisocoria, loss of pain and temperature of the right face, and loss of pain and temperature of the left arm and leg. An MRI of the brain is performed and shows a stroke. What other symptom is often also a part of the syndrome this patient is experiencing?

Which of the following is an absolute contraindication for the use of tPA?