Quiz 07/19/2022 (1)

What findings would be found on EMG/NCS in a patient who presents with a small fiber neuropathy?

A 32-year-old woman with a known history of relapsing-remitting multiple sclerosis currently on ocrelizumab presents to the emergency room with the concern of having a demyelinating attack. An MRI brain with contrast shows a single, ovoid, juxtacortical white matter lesion with contrast enhancement that was not present on her last MRI scan. Which of the following is the most appropriate next step in medical management?

An 8-year-old boy with no significant past medical history is brought to the clinic due to difficulties in school. His mother states that over the past year, she has received multiple phone calls from his teacher about his lack of concentration in class. On multiple occasions when asked a question, the patient would blankly stare at the wall and ignore the teacher, but then would return to his normal, talkative self immediately after each episode. An EEG is ordered, which shows 3 Hz generalized spike and wave discharges. The patient would most likely benefit from a medication targeting what?

Which of the following identifies the sigmoid sinus?

A 65-year-old man with a past medical history of chronic liver disease and diabetes presents with progressive falls and a tremor. On exam, he is rigid throughout with significant gait instability, a tendency to turn his head to the right, and a hypertrophied left sternocleidomastoid muscle. He fails initial treatment with carbidopa-levodopa. His brain MRI reveals T1 hyperintensities of the bilateral globi pallidi. Which of the following is the most likely diagnosis?

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

You are asked to evaluate a patient in the neurointensive care unit who is comatose and has had a somatosensory evoked potential performed. Which of the following is most suggestive of a poor prognosis for this patient?

A nine-month-old boy with no significant past medical history is brought to the clinic by his mother because of paroxysmal episodes of unknown etiology. His mother states that since he was six months old, she noticed that his head would intermittently tilt to his right lateral side when he woke up. His head tilt would always disappear during sleep. During these “attacks” the patient would become irritable and would occasionally vomit. The symptoms last up to 48 hours before resolution. Imaging of the brain and EEG do not demonstrate any abnormalities. Which of the following is the most likely cause of these symptoms?

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?

What is the pathophysiology of the lesion provided below?

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

Initiating HAART therapy for a patient with poorly controlled HIV places them at an increased risk for which of the following?

A 57-year-old teacher presents to the clinic with reading difficulties. His first symptoms developed 12 months ago when he had trouble marking students’ homework. He progressively also lost the ability to write and had to retire from his profession. Now he needs help tying his shoes and buttoning his clothes. His visual acuity is 20/20. Funduscopic examination and the rest of the neurological examination are unremarkable. Which of the following is the most likely diagnosis?

A 42-year-old man presents to the emergency department with recurrent falls, mild confusion, and visual changes. Physical examination reveals a wide-based gait, nystagmus, and ophthalmoplegia. Deficiency in which of the following is the most likely cause of the patient’s symptoms?

A 21-year-old male with a history of cirrhosis, dysarthria, and personality changes was brought to the emergency room after experiencing a 20-minute episode of right-sided weakness. An MRI was performed to evaluate for a possible stroke. An axial cut of a FLAIR sequence is provided below. What is the likely diagnosis of the patient’s chronic illness?

Which of the following medications are known to develop neutralizing antibodies (NAbs) against it with chronic use?

Which of the following is a side effect of glatiramer acetate?

Which of the following arteries supplying the thalamus provides supply to the lateral geniculate nucleus (LGN)?

Chronic exposure to which of the following medications can cause the pathology appreciated on the pathology slide below?

What is the most appropriate therapy for the infection depicted in the pathology slide below?

A 40-year-old with AIDs (CD4 count 60) presents to the emergency room with a 2-month history of progressive headache, confusion, and left sided weakness. MRI brain with and without contrast was performed and it showed ring-enhancing lesions in the basal ganglia and the right frontal lobe. A brain biopsy was performed and shown below. Which is the most likely diagnosis?

A 35-year-old male presents to the neurology clinic for the management of seizures. The patient reports having focal to bilateral tonic-clonic seizures (FTBTC) since the age of 15. His seizures are usually preceded by the smell of burning rubber. He will then have left hand automatisms followed by whole-body tonic-clonic activity. Levetiracetam monotherapy was initially effective. However, 1 year ago seizures returned, occurring once every two months. Lacosamide was added 6 months ago but there has been no significant improvement in his seizure frequency. Levels of these two anti-seizure medications (ASMs) are therapeutic and there have been no concerns regarding medication adherence. What is the most appropriate next step in management?

This pathology slide is most consistent with which of the following diseases?

Which way are the patient’s eyes moving at the point of the asterisk marked below?

An 18-year-old boy had an MRI performed after experiencing a first-time seizure shown below. What genetic disorder could be the cause of the abnormalities appreciated on imaging?

A lesion to which of the following neuroanatomical structures causes dysphagia, decreased gag reflex, and hoarseness?

A patient with newly-diagnosed early state amyotrophic lateralized sclerosis (ALS) presents to your multidisciplinary clinic for the first time. After discussing the effectiveness and side effects of riluzole and endavarone, the patient informs you that he doesn’t want to start either medication. Which of the following basic principles of medical ethics could be best applied to this scenario?

A newborn is evaluated in the NICU hours after birth to a G1P1 mother with poor prenatal care at 36 weeks. Upon evaluation, the newborn is macrocephalic, jaundiced, and hypotonic. She also has a faint purpuric rash on her extremities and redness of both eyes. CT of the head shows periventricular and basal ganglia calcifications. This condition is likely caused by which of the following organisms?

A 32-year-old female with an acute ischemic stroke was sent for an urgent angiography. Below is the image captured from this study. What is the likely etiology of the patient’s acute ischemic stroke?

A 24-year-old woman presents to the ER with a one-day history of diplopia. On examination, the patient has right internuclear ophthalmoplegia. On further discussion, she describes an episode of left lower extremity numbness about 2 years ago that resolved after a few weeks on its own. An MRI of her brain and spinal cord was ordered. Findings included a T2 hyperintense contrast-enhancing lesion in the pons, as well as non-contrast enhancing T2 hyperintense lesions in periventricular and juxtacortical regions as well as in the thoracic spinal cord. What is the next step to confirm her diagnosis?