Quiz 07/21/2022

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

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?

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

A 75-year-old patient is brought by her husband because of word-finding difficulty. On cognitive testing, the most impressive finding was that the patient couldn’t recall many colors of the rainbow. Based on this finding, what kind of memory is most impaired?

A mother and father bring in their 8-month-old son to your clinic for clinical events described as sudden flexion of the limbs and trunk, seen most often upon awakening or falling asleep. His interictal EEG is demonstrated below. Which of the following is the most likely cause of the patient’s symptoms and EEG findings?

Which of the following medications can potentially reduce the platelet inhibition of clopidogrel?

A 71-year-old male with a history of mild ankle weakness and balance issues for the last 6 years is referred to the lab for a nerve conduction study (NCS). While performing the testing the patient states that a few of his siblings, as well as his father, had similar issues. Examination showed high arches and hammertoes. Based on the clinical history and NCS, what is the most likely diagnosis?

A 67-year-old male presents to the clinic with his wife due to a gradual decline in his balance over the past two years. His balance issues have resulted in him falling twice in the past month. His wife states that she notices that he has been walking more slowly than usual. The patient also complains of double vision when reading the newspaper. On physical exam, the patient is noted to have a vertical gaze palsy and impaired smooth ocular pursuit, and a subtle right hand resting tremor. A brain MRI is ordered which shows atrophy in the midbrain tegmentum. What is the most likely diagnosis?

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?

In the diagram below, what neurologic information is carried by the tract labeled with the green arrow?

What is a common comorbid issue seen in newborns with the vascular abnormality appreciated in the imaging provided?

Match the phase of the Valsalva maneuver with its associated physiology.

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

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

A 57-year-old male undergoes a cervical decompression laminoplasty for myelopathy, and on postoperative day #2, he complains of severe left shoulder pain. On examination, he has weakness with abduction of the left arm at the shoulder and flexion of the left arm at the elbow. This patient’s lesion localizes to which nerve root?

Which is the following potentials on EMG has an irregular firing pattern?

A 33-year-old woman has recently given birth to a healthy 3-month-old boy. She has been complaining of poor sleep for the past year, mainly from an uncontrollable urge to move her legs that is only relieved by moving them. This is present during the day to a small degree but is much worse at night and during periods of rest. What would be the best test to order for her?

A lesion to which of the following hypothalamic nuclei causes hyperphagia?

This brain biopsy is representative of which of the following tumors?

Anti-GQ1b antibodies are associated with which syndrome?

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?

An 8-year-old girl is noted to have staring spells during class by her teacher. In the office, you are able to provoke an event by having her blow repeatedly into a pinwheel. What is the most likely underlying pathology of her disease?

An 85-year-old woman presents to the hospital with an acute onset of language impairment. On examination, she has difficulty with comprehension but her verbal fluency and repetition are normal. Which of the following best describes her deficits?

Which of the following symptoms can be seen with MCA-PCA watershed infarcts?

A 26-year-old female presents with unilateral vision loss. She says that she noticed the symptoms upon awakening yesterday morning and has gotten progressively worse since then. On neurological examination, she has 20/70 visual acuity of the left eye and 20/20 of the right. There is a left afferent pupillary defect (APD). Extraocular movements are intact but cause pain. What is the most appropriate treatment?

Which of the following medications has a relatively low risk of sexual dysfunction?

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?

A 9-year-old boy presents to the clinic with complaints of gait and speech trouble. His mother reports he started walking “like he was drunk” a few months ago. He had genetic testing that confirmed a trinucleotide GAA repeat expansion in one of his genes. Which of the following findings on physical exam is least likely to be present?

A 40-year-old male is referred to the clinic for a one-year history of progressive weakness of the upper and lower extremities. Past medical history is impressive for thrombocytopenia, anemia, and hepatosplenomegaly. Neurological examination shows 2/5 strength in the distal lower limbs bilaterally with diminished ankle and patellar reflexes. The sensory exam shows diminished vibratory and pinprick sensation in both legs. He also has a markedly orange discoloration of his tonsils. Genetic testing is performed which reveals a mutation in the ABCA1 gene. Which of the following is the most likely diagnosis?

An 80-year-old woman with a history of Parkinson’s disease that is well controlled with carbidopa-levodopa presents with her husband for evaluation of delusions. Her husband states that the patient believes that she is being consistently monitored by the FBI and will avoid eating certain foods for fear of being poisoned. She is also constantly worried that her husband will leave her for a younger woman. Which of the following medications would be the most appropriate FDA-approved treatment for these symptoms?

What is the electrographic pattern seen best in the right temporal electrodes?

A 24-year-old college student presents with uncontrolled epilepsy. His seizures consist of an aura of déjà vu followed by oral automatisms and periods of unresponsiveness. The neurological examination is normal. MRI of the brain is performed and shown below. What is the etiology of this patient’s epilepsy?

An 8-year-old girl is brought to the clinic by her mother for complaints of progressive insomnia, difficulty walking, and worsening vision. On exam, the patient is found to be unable to look upwards and her pupils accommodate but fail to react to light. On further questioning, it is found that menarche occurred at 7 years of age. MRI is most likely to demonstrate a tumor of which brain structure?

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 Duchenne muscular dystrophy (DMD) most likely has which of the following findings on electromyography (EMG)?

Which of the following is characteristic of a left internuclear ophthalmoplegia?

A 1p/19q co-deletion is associated with which of the following tumors?

Which of the following is classically seen on electromyography in a patient with an acute neuronal injury?

A 30-year-old male presents to the clinic with a fifteen-year history of progressive weakness and sensory loss in his lower extremities. Examination shows hammertoes, high arches on his feet, 4/5 ankle dorsiflexion strength, and a mild decrease in sensation to pinprick in the 1st toes bilaterally. Upon questioning he mentions that his father had similar-looking feet and started to use a cane in his fifties. What is the most likely diagnosis for his symptoms?

A 1-year-old female with a past medical history of iron deficiency anemia presents to your clinic with her mother for recurrent episodes of loss of consciousness. Her mother states that whenever she gets very agitated and starts crying, her lips turn blue and she will ”pass out.” She will then awaken after a few seconds. Her neurological exam is normal. Which of the following is the most likely cause of her episodes?