Quiz 07/23/2022

A 32-year-old man with a 4-week history of painful swelling on his right forehead presents to the emergency room. A CT scan of the head was performed and is shown below. What is the most likely diagnosis?

A 62-year-old 50 kg female with a history of myasthenia gravis presents to the hospital with shortness of breath and generalized weakness felt to be secondary to a myasthenic crisis. Her medication history in the chart states she is currently taking pyridostigmine 60 mg QID, prednisone 20 mg daily, and just started cyclophosphamide 4 weeks ago. She was safely intubated in the ED with a NIF of -18 cm H2O and a VC of 600 ml. Select the appropriate next steps regarding pharmacotherapy and management for a myasthenic crisis.

I. Discontinue pyridostigmine
II. Increase the dose of prednisone
III. Increase the dose of azathioprine
IV. Consult general surgery for thymectomy
V. Consider PLEX or IVIg therapy
VI. Start rituximab

A 12-year-old boy with a past medical history of sickle cell disease was admitted to the emergency room in a pain crisis. While being treated with morphine the patient developed acute left arm/leg weakness and numbness. Which of the following is the most likely etiology for the patient’s new neurologic symptoms?

A pure sensory stroke is most likely to damage which structure?

A 24-year-old female in her third trimester of pregnancy, with no other past medical history, presents with complaints of 1-2 times monthly episodes of sudden onset severe room spinning, nausea, and vomiting for 3 months. They happen randomly and are not associated with head movement. During an episode, sounds and bright light seem to bother her more. She denies motor weakness or hearing change. Her spells resolve after about 1 hour. She endorses she has had bad headaches in the past, but not with these episodes. She endorses she gets car sick easily. On neurologic examination, she has no focal findings, and her vitals are within normal limits. She had an MRI brain with MRA and MR Venogram, all of which were unremarkable. Which is the most likely etiology?

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?

A 58-year-old male presents with a few months of progressive symptoms. He reports limb rigidity, left greater than right, as well as neck stiffness. On exam, you note bradykinesia and cervical dystonia. He does not have a tremor. Speech is hesitant, and there is evidence of speech apraxia. You also note that the patient has trouble controlling the location of his left hand in space, and he grabs for your stethoscope without realizing it.

What is the most likely diagnosis?

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?

Which of the following findings would most likely be found on histopathological analysis of the lesion shown in the image below?

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

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?

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?

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

An 82-year-old female presents with her family for a 3-year slow decline in memory. On examination, she has a MOCA of 23/30. She does not feel that she has any issues, but her family feels that she has trouble remembering important dates in her life and will repeat stories to them. Despite this, she has lived alone since her husband died 2 years ago and is able to cook, clean, and bathe on her own. She also balances her own checkbook and does her own grocery shopping. According to the DSM-V, this patient meets the criteria for which disorder?

A 23-year-old female with a past medical history of depression presents with right arm paralysis that started after she found out her boyfriend died from a motor vehicle accident. Her physical exam shows no effort during muscle strength testing and positive withdrawal when a noxious stimulus is applied. The rest of the neurological examination, including reflexes, was normal. MRI of the brain and cervical spine were unremarkable. Which of the following is the most likely diagnosis?