Quiz 07/19/2022 (1)

A 56-year-old female presents to the clinic with right posterior leg pain. On examination, there is decreased sensation of the right posterior calf and weakness in right ankle plantarflexion. EMG testing shows fibrillations of the gastrocnemius and gluteus maximus muscles. EMG testing of the tibialis anterior, gluteus medius, and tensor fascia lata were normal. What is the most likely etiology of this patient’s symptoms?

A 57-year-old navy veteran with a history of PTSD presents with a 2-year history of progressive, asymmetric weakness. The patient states that symptoms started in his left arm. Six months later he started to have falls due to tripping over his right foot. His neurological examination shows weakness of the intrinsic hand muscles of the left arm, ⅖ strength on dorsiflexion of the right ankle, and no sensory disturbances. Reflexes were mute in the left upper extremity and there were several beats of clonus at the right ankle. Fasciculations were present in the tongue, right gastrocnemius, and left tibialis anterior. An EMG is recommended for diagnosis. Which of the following EMG findings are most likely seen in this patient?

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 56-year-old man with a history of a kidney transplant, on tacrolimus, presented to the hospital with a 2-week history of progressive confusion and expressive aphasia. An MRI brain with and without contrast was performed and shown below. A brain biopsy was performed and showed microglial nodules with encysted bradyzoites and tachyzoites. Which of the following is the most appropriate therapy?

A 35-year-old woman with a past medical history of ocular and oral dryness presents with a 5-month history of progressive difficulties with ambulation. On exam, there is diminished vibratory sensation along the plantar/dorsal surfaces of her feet, 1+ ankle reflexes bilaterally, and a positive Romberg sign. Strength is normal. A tissue biopsy confirms the diagnosis. Which of the following is the most likely diagnosis?

Which of the following is the mechanism of action for amantadine?

A mutation in which of the following genes would be most likely in a patient with numerous cavernous malformations seen on head imaging?

A 20-month-old female presents for regression of milestones. She was walking, and now crawls or refuses to move. The parents are concerned she may be having seizures because they notice she has intermittent jerks of the limbs and trunk, especially when she is startled. on physical exam, you note conjugate random darting of the eyes in vertical and horizontal directions. Tone, strength, and deep tendon reflexes are normal.

What test is most likely to identify the underlying etiology of this problem?

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

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

Which of the following primary CNS tumors carries the highest risk of disseminated metastatic disease through the spine via CSF seeding?

A 48-year-old man with a 20-year history of HIV stable on HAART therapy presents to your clinic accompanied by his partner who states that the patient has had mounting difficulties over the last 3 years. Most recently he has been unable to effectively manage finances, cook for himself, or arrange appointments. What is the best diagnosis at this time?

Identify the structure labeled 4 in the angiograms provided below.

Which of the following medications do not worsen myasthenia gravis symptoms?

A 35-year-old female with a diagnosis of bipolar disorder is being seen in the clinic for the first time with a history of progressive difficulties walking. On examination, there was difficulty in fine motor movements and decreased arm swings with ambulation. A CT scan was performed and shown below. What is the most likely diagnosis?

Which of the following can not cross the blood-brain barrier via channel-mediated transport?

A 57-year-old male with recently diagnosed small cell lung cancer (SCLC) is presenting to the electromyography lab with a one-month history of muscle cramps and muscle pain. Percussive myotonia is appreciated on examination. Electromyography showed myokymic discharges. Autoantibodies against which of the following channels are likely present in this case?

A 37-year-old woman treated for herpes simplex virus (HSV) encephalitis two months ago returns to the ER with new personality changes, seizures, and orofacial dyskinesia. What is the most likely diagnosis?

A 74-year-old female presents to the ED for trouble with swallowing and balance. On physical examination, she is unable to speak clearly and has no gag reflex. Pain and temperature sensation on the right side of her body and the left side of her face is decreased. She is unable to walk unassisted and has dysmetria on the finger-to-nose exam. MRI of the brain shows an ischemic stroke. The artery that is affected most commonly branches off of which of the following?

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

A neurology consult was placed for a 35-year-old male who was admitted overnight after a motor vehicle accident that occurred earlier in the day. He experienced multiple bone fractures, including the right humerus at the spiral groove. The primary team is concerned about a radial nerve injury. Which of the following findings are most likely to be found on EMG/NCS?

Identify the lesion below.

A patient who was admitted to the neurology intensive care unit for myasthenic crisis developed ventilatory-associated pneumonia on the fifth day of his hospitalization. On the day following the initiation of antibiotic therapy, there was a significant decline in the patient’s respiratory status. Which of the following antibiotics most likely contributed to the patient’s respiratory distress?

Motor unit action potential (MUAP) conduction velocities of a newborn are what percentage of an adult?

A 75-year-old man with a past medical history of hypertension, hyperlipidemia, and diabetes presents with acute onset right arm weakness and speech problems. He can speak fluently and his comprehension is intact. However, he is unable to repeat even simple sentences. Reading and writing are preserved. Which of the following is an accurate description of his speech dysfunction?

What is the earliest NCS/EMG abnormality found in AIDP?

Congenital muscular dystrophies are most often associated with which of the following pathophysiologies?

A four-day-old, full-term male with an uncomplicated vaginal delivery is brought urgently by his mother to the clinic after an episode concerning for possible seizure. His mother states that this morning when she accidentally dropped a pile of dishes on the floor, the child “tensed up”. She states that both his upper and lower limbs became rigid and he had violent jerking movements of all limbs for approximately 40 seconds. This patient’s condition is most likely due to a mutation in which of the following genes?

You are caring for a patient in the Neuro ICU for loss of consciousness after 3 convulsive episodes within a 2 hour period. She required intubation with rocuronium and sedation with propofol. She was loaded with 2000 mg of Keppra and had received 2 mg of Ativan in the ED. You obtain a spot EEG and left temporal epileptiform discharges are seen, but no additional seizures. Unfortunately, your hospital does not have continuous EEG capabilities. Of the following options, which physical exam change in this paralyzed patient is most likely to indicate potential repeat seizure and prompt stat repeat spot EEG and consideration of antiepileptic bolus?

Which of the following is the resting membrane potential of a neuron?

A 58-year-old woman presents with worsening memory loss and a 50-pound weight gain over the past six months. On neurological exam, her Mini-Mental Status Examination (MMSE) yields a score of 21/30. She has intact sensation, normal muscle bulk, tone, and strength, but diffuse hyporeflexia. Which of the following is most likely the diagnosis?

A 6-month-old full-term female is referred to the clinic with persistent right shoulder and elbow weakness since birth. Which of the following is the most likely pathologic lesion?

Where is the anatomic origin of the normal EEG sleep structure seen in the 3rd second of this recording?

A 34-year-old male presents with personality changes that started after a motor vehicle accident-related traumatic brain injury. His family has noticed that since the accident, the patient no longer actively seeks out hobbies that he once enjoyed. He will often forget to eat meals unless prompted, even if the food is placed in front of him. Which of the following medications would most likely help with his behavior?

A 6-year-old female is seen in the clinic for decreased balance and numbness in her fingers and toes. Her father, who is with her at the clinic visit, states that she was developmentally normal until 2 years of age, at which time she began to have frequent falls. During the past year, she has also developed slurred speech. The neurological exam reveals truncal ataxia, ataxic gait, scanning speech, and decreased sensation to vibration and pinprick in her extremities. The ocular exam reveals irregular capillary dilation of the retina and skin. What is the most likely diagnosis?

Which of the following is the antibody associated with dermatomyositis that is known to confer the highest risk of cancer?

Optic nerve glioma is associated with which of the following diseases?

Which of the following is not a recommended screening test for cognitive dysfunction?

A 45-year-old male with AIDs presents with headache and fever. His recent CD4 count was 80, and he does not take his HAART therapy or prophylaxis. You perform a brain MRI (shown below) and discover a contrast-enhancing lesion with much vasogenic edema. With concern for cancer, a biopsy is performed. It shows microglial nodules with encysted bradyzoites and tachyzoites. What is the treatment of choice?

The medulla develops from which of the five primary vesicles of the brain?

Which of the following antiplatelet medications rely heavily on the cytochrome P450 system for its therapeutic effect?

A 26-year-old female presents to the hospital following a sudden onset headache and decreased responsiveness. A CT Head is obtained (left) followed by a cerebral angiogram (right). Which of the following is the most likely cause of the patient’s symptoms?

A 57-year-old woman with a past medical history of hypothyroidism was referred to the EMG lab with a one-year history of right-hand numbness. Based on the EMG data shown below, what is the most appropriate next step in medical management?

A blood clot in which artery explains the findings below?

Identify the pathologic finding marked by the red arrow.

An 87-year-old male presents with a 2-year history of worsening cognitive decline and speech difficulties. Brain MRI reveals multiple chronic cerebral infarcts. The neurological exam reveals adequate comprehension and fluency but naming was impaired. What is the most likely diagnosis?

An 82-year-old female patient with a history of atrial fibrillation is brought to the emergency department after being found down at home. She is unable to move her extremities, although she is able to blink and move her eyes vertically. Occlusion of which artery/arteries is the most likely cause of her symptoms?

A 40-year-old textile worker is brought to the clinic for slowly progressive symptoms including shuffling gait, tremor, and profuse drooling. On examination, his speech is difficult to understand and there is cogwheel rigidity in his arms and legs. His tremor is most evident when his limbs are at rest. Exposure to which of the following is the most likely cause of the patients’ symptoms?

A patient with medically refractory epilepsy secondary to mesial temporal sclerosis recently had a right hemispheric anterior temporal lobectomy. He is complaining of a post-operative visual field deficit. Which of the following is most likely to be appreciated on the exam?

A 31-year-old female who recently delivered a healthy boy 3 days ago comes into the emergency room with a headache and vomiting. Other than requiring an epidural for pain management, the delivery of her child was uncomplicated. Her neurological exam is normal. A brain MRI was completed and is shown below (Left: T1, Right: T2 with contrast). Which of the following is the most likely diagnosis?