Quiz 07/18/2022

A 35-year-old man developed a right clavicle fracture after an accidental fall from a ladder while hanging Christmas lights. He was treated conservatively with a figure-of-eight bandage and sling. He presents to your clinic 2 weeks after the accident. He states ever since the accident he has had right arm and shoulder pain, as well as numbness extending from his triceps to his middle dorsal aspect of the forearm, wrist, and dorsal aspect of digits 1,2 and 3. On examination, his strength is 5/5 throughout all extremities except 4/5 to abduction of the deltoid, extension of the triceps, and wrist extension.

Which nerve or cord, if injured by the clavicle fracture, would explain his symptoms?

Which of the following genes is responsible for familial ALS?

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?

A 56-year-old man with a past medical history of hypertension and type II diabetes presents to the hospital with acute onset left-sided weakness which started 90 minutes prior to your evaluation. His only medications prior to admission were metformin and verapamil. Vitals were within normal limits except for a blood pressure of 154/92. Physical examination reveals 3/5 weakness in the left arm, leg, and face as well as a moderate sensory disturbance in the same regions. CT head was unremarkable and CT angiogram (CTA) showed no large vessel occlusion. A brief history gathered from his wife revealed no other comorbidities or active medical issues. At this point in his clinical presentation, what is the mechanism of action of the most appropriate therapy?

A 19-year-old woman presents for evaluation of paroxysmal episodes of vertigo, spasticity, diplopia, and ataxia. She reports that her father and one of her two sisters have similar ailments. At the time of the appointment, there was no diplopia or ataxia appreciated. Myokymia was appreciated on electromyography. Which of the following is the most likely diagnosis?

A 46-year-old female presents to the clinic with complaints of recurring headaches. She states that she experiences episodes of sharp pain in her left cheek, which is exacerbated by eating or a cold wind blowing on her face. Outside of these triggers, she is largely pain-free. She doesn’t endorse any associated rhinorrhea, lacrimation, or facial flushing. Which of the following is the most appropriate treatment for her disease?

A 25-year-old male with a history of sensorineural hearing loss and tinnitus has an MRI brain ordered as part of his workup (see below). A genetic syndrome is suspected. Which of the following is also likely to be found on imaging?

A 32-year-old female with a history of schizophrenia is brought to the emergency room by her husband for acute psychosis. She receives a medication while in the emergency room to aid in her agitation. Soon after administration, the patient develops involuntary contractions of muscles of her face and neck. Which of the following medications was most likely administered to cause these symptoms?

The pathology shown in the image below is likely secondary to which of the following?

A 40-year-old male with a history of headaches, seizures, and recurrent strokes has a brain biopsy performed to aid in diagnosis. Electron microscopy of his brain tissue shows granular osmiophilic material in the basal lamina of small cutaneous arterioles. What is the cause of this patient’s disease?

A 4-year-old boy is in the hospital for headache and abdominal pain and is being treated by the pediatric service for possible constipation, for which they have given polyethylene glycol. You are consulted due to the new onset of inability to extend his left wrist. On exam, you note a bluish coloration of the gingiva.

A peripheral blood smear is requested and shows microcytic RBCs with basophilic stippling. Anemia in this disease is caused in part by inhibition of which of the following?

Which of the following pathologic findings is associated with posterior cortical atrophy?

Which of the following are actions of the superior rectus muscle?

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

The usage of bupropion increases the risk of which of the following?

The epileptologist’s EEG report for a patient in the neuro-ICU identifies a “burst suppression” pattern. Which of the following is not a criterion required to diagnose burst suppression?

A 67-year-old woman suffers from sustained involuntary contraction causing her head to be forcibly turned to the right and significant discomfort. On exam, her left sternocleidomastoid is significantly hypertrophied. She receives treatment with Botulism Toxin A. Subtype A of botulism toxin acts to reduce synaptic action of acetylcholine by what mechanism?

A 42-year-old woman with major depressive disorder and anxiety who has recently completed treatment for gambling addiction presents with a unilateral upper extremity resting tremor and the feeling that she is “stiff all of the time”. Her husband remarks that she has become much more soft-spoken lately and that five years ago she began acting out her dreams. Which of the following medications should be avoided in this patient?

A previously healthy 25-year-old female presents to the emergency room with lower extremity weakness, numbness, and urinary retention. Lower extremity hyperreflexia and a sensory level at T10 were appreciated on examination. A contrasted cervical/thoracic and lumbar MRI was performed and shown below. Lumbar puncture was performed after imaging was completed and showed an elevated protein concentration, normal glucose, 3 WBCs, and oligoclonal bands. Rheumatologic studies are negative. Based on the most likely diagnosis, what is the most appropriate next step in medical management?

A two-week-old, full-term female with an uncomplicated delivery is brought to the clinic with abnormal jerky movements. Her father states that episodes occur right after the patient is put down for a nap, last for roughly 3 minutes, and resolve with arousal. During the episodes, the patient has rapid, repetitive myoclonic movements of her upper limbs. The physical exam is unremarkable. The patient was admitted to the Epilepsy Monitoring Unit where a typical event was captured and had no EEG correlate. Which of the following is the most likely diagnosis?

Which of the following findings is depicted in the catheter angiogram shown?

Which of the following EEG patterns is typically seen over the age of 50?

A 30-year-old man with a past medical history of migraines presents to the emergency department for his typical migraine symptoms, which have become intractable. He is treated with a “migraine cocktail” (normal saline, acetaminophen, and prochlorperazine) with some improvement. You are then called to the bedside for concern that he is having a possible seizure. His head is turned forcibly to the right without eye deviation and he is able to follow commands and verbalize. Which of the following is the best next step in management?

A 25-year-old female presents to the clinic with headaches for a year that occur two to three times a month. The pain usually occurs on one side and is associated with nausea and light and sound sensitivity. During these episodes, she is unable to go to work. Over-the-counter anti-inflammatories are ineffective. Physical exam and vitals are normal. Which therapy is the most appropriate next option in treatment?