Quiz 07/20/2022 (1)

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?

The cell marked by the blue arrow is derived from which germ layer?

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?

A 58-year-old female with a history of atrial fibrillation on warfarin presents to the ED with aphasia and right-sided weakness. She was last seen well 2 hours prior. CT imaging is unremarkable. Which is the most appropriate next step?

The thalamus and hypothalamus are derived from what embryonic structures?

A 64-year-old woman is brought to the office by her husband for changes in her speech pattern. While neurocognitive testing was largely unremarkable, her spontaneous speech appears effortful, halting, and laced with grammatical errors. MRI of the brain revealed left posterior frontal and insular atrophy. Which of the following is the most likely diagnosis?

A 45-year-old female presents to the emergency room after experiencing a first-time seizure. On examination, she has some mild RUE weakness and anomia. MRI w/o contrast was performed and shown below. Which of the following is the likely cause of her lesion?

A 45-year-old man presents to the clinic with a disc of the following MRI. Which symptom is the patient likely experiencing?

A 61-year-old male with a past medical history of GI cancer status post gastric resection at age 57, consequently on parenteral nutrition, presents to your clinic for a second opinion. He complains of slow movements and rigidity in his arms and legs that have slowly progressed over the last year. He denies tremors or cognitive change. He saw a different neurologist who started him on carbidopa/levodopa 6 months ago but the response has been minimal and he continues to get worse. You decide to perform a brain MRI and you see bilateral hyperintensity of the globus pallidi on the T1-weighted image. What treatment should you add?

A thin 28-year-old male presents to the clinic with complaints of foot drop. On exam, he has a right foot drop as well as numbness on the lateral aspect of the right lower leg. You suspect compression of a nerve at the fibular head. Malfunction of which of the following nerves causes the foot drop itself?

A 60-year-old female with a past medical history of chronic alcohol use was admitted to the hospital 4 days ago for community-acquired pneumonia. Over the last 48 hours, the patient developed severe encephalopathy and generalized weakness. An axial T2 FLAIR MRI is shown. Which of the following is the most likely diagnosis?

A 33-year-old female presents to the clinic for evaluation of a left lower extremity foot drop. On physical examination, there is weakness in dorsiflexion. Ankle eversion, inversion, and plantar flexion strength are normal. Hip abduction strength is normal as well. Which of the following is the most likely etiology for the patient’s symptoms?

A 35-year-old male with a past medical history of intravenous drug use presents with back pain, fever, anorexia, and generalized weakness. An MRI of his sagittal spine is shown below. Which of the following is the most likely diagnosis?

Which of the following vessels that supply the thalamus originates from the P2 segment of the posterior cerebral artery and supplies the medial geniculate nucleus?

Which of the following structures are not supplied by the posterior cerebral artery (PCA)?

Based on the EEG shown below, how old is this patient?

A 28-year-old female is brought to the emergency room by her husband because of behavioral changes and memory issues over the last 4 days. Right after the MRI, shown below, the patient had a tonic-clonic seizure. Based on the limited clinical history and imaging provided, which of the following is the most likely diagnosis?

A 6-year-old male with a history of medically-refractory epilepsy (on three anti-seizure medications), and right-sided-hemiparesis, presents to the emergency room with a three-day history of continuous right facial twitching. Symptoms persist during sleep and have not responded to benzodiazepines. On examination, the patient has retained awareness despite the continuous facial movements. MRI brain was performed and shown below. Of the following, which is the most appropriate therapy to achieve seizure freedom?

A 40-year-old woman is hospitalized at an inpatient psychiatric facility for new behavioral disturbances and a suicide attempt. She has also begun to develop unusual movements of her bilateral upper extremities. The movements are non-rhythmic, high-amplitude, low-frequency, and involve the entire extremity. Her brain MRI is shown below. Which of the following may help to treat her movements?

What sensitivity should the EEG be at to qualify for brain death criteria?

This muscle biopsy is most consistent with which myopathic disease?

According to the Bouthillier Classification, which segment of the internal carotid artery is colored below in orange in this sagittal angiogram?

Opsoclonus-Myoclonus Syndrome (OMS) is associated with which autoimmune antibody?

A 20-year-old female presents to the clinic with weakness and numbness in the right leg. She states that earlier in the day she was taking a long nap on her right side, and when she awoke, her entire leg felt like pins and needles. When she got up, she felt that she was dragging her right leg on the floor. She has had similar experiences in other limbs over the years but symptoms would slowly improve over weeks. Nerve conduction studies showed a right common peroneal nerve conduction block and mildly decreased conduction velocities of all nerves tested. Her mother reports that her father had similar episodes before he passed away from an unrelated illness. Which of the following is the most likely diagnosis?

Which of the following is present in the image shown below?

Which of the following can be appreciated on the T1 MRI sequence shown below?

A 40-year-old woman of Chinese descent has a cerebral angiogram performed after experiencing recurrent ischemic strokes over the past 5 years. This image is most consistent with which neurological disease?

Neimann-Pick disease occurs due to a mutation of which of the following enzymes?

Which of the following is not a risk factor for the development of natalizumab-associated PML?

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 a necessary requirement for electrocerebral inactivity (ECI) testing?

What task is likely being performed during this EEG recording?

An autopsy was performed on a 30-week gestational age stillborn infant. An image of the brain before histopathologic analysis is shown below. Which of the following was likely also appreciated during the autopsy?

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?

A patient with a history of a chronic ischemic stroke has an MRI performed for new-onset seizures. Based on the imaging provided, what is the likely etiology of the patient’s past stroke?

A 50-year-old male presents to the emergency room with a three-day history of double vision and difficulty walking. Neurological examination reveals decreased eye movements. Strength in the limbs is relatively preserved but all reflexes are absent. There is also marked limb clumsiness. Which of the following is the most likely diagnosis?

An 11-year-old girl has a neurosurgical resection of a brain mass. You are consulted post-op day 2 due to speech decline progressing to complete mutism. She does not have any weakness on exam. What type of tumor was most likely resected?

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

A 3-year-old male with a history of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) was referred to neurology by his PCP for concern of a genetic disorder. On examination, the patient appears to have a long face, large ears, and a prominent jaw. Genetic testing shows that the patient has a pathologic gene mutation with over 200 trinucleotide CGG repeats. Which of the following is a comorbidity appreciated in this patient’s neurologic syndrome?

A 33-year-old patient presents in the clinic for evaluation of bilateral leg weakness, and urinary incontinence. He first started noticing right leg weakness about 2 years ago and then a few months later felt similar symptoms developing in his left foot. These symptoms gradually worsened over time to the point that he had to start using a cane because of frequent falls. Imaging of the whole neuroaxis was performed. MRI of the brain showed several periventricular and juxtacortical T2 hyperintensities with no enhancement. A lumbar puncture was performed and it had unique CSF oligoclonal bands. What is the most likely diagnosis?

A 65-year-old female comes to the clinic complaining of weakness in his extremities. Symptoms are more prominent in the legs than in the arms. Oddly, when he tries to exert himself, he notes an improvement in his strength. Neurodiagnostic testing reveals low amplitude compound muscle action potentials (CMAPs) with an increase in amplitude on high frequency (50 Hz) rapid repetitive stimulation. Which of the following malignancies is most closely associated with this patient’s neurologic syndrome?

A 78-year-old male with a past medical history of depression and chronic alcohol use presents to the clinic with his wife for evaluation of a tremor. He states that the tremor is most severe at rest and disappears with purposeful movement. His wife states that he has been having slower movements over the past year. On physical exam, a “pill-rolling” resting tremor is noted in his left hand and the patient has difficulty with gait initiation and takes short steps when walking forward. Which dopaminergic pathway is most likely affected in this patient?

A 35-year-old Dominican Republic immigrant is brought to the emergency room for a first-time seizure. He is currently back to baseline and has a normal neurological exam. His only complaint is a multiple-month history of chronic headaches. A head CT scan is performed and shown below. Which of the following is the most likely etiology of his symptoms?

A 73-year-old male with a past medical history of hypertension, hyperlipidemia, and atrial fibrillation presented to the emergency room with an acute onset of language difficulties. On examination, his speech is nonsensical but fluent. He is unable to understand commands, but repetition is intact. Which of the following best describes this patient’s aphasia?

Which of the following comorbidities are responsible for the lesion appreciated in the image below?

A consult is placed for paroxysmal episodes in a 6-day-old male infant born at 32 weeks gestation. According to his mother, the infant seems to be shivering a lot “like he is cold”. The mother states that she has been wrapping him in warm blankets and keeping the room at a warm temperature. On physical exam, the infant is alert and interactive, without persistent focal neurological deficits. However, when touching the left arm, the patient develops a fine tremor that resolves after flexing the affected limb. Vital signs are within normal limits. Which of the following is the most likely diagnosis?

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

Which of the following medications may be unsafe for the treatment of migraine headaches in patients with a history of coronary artery disease (CAD)?