Quiz 07/24/2022 (1)

Identify the lesion below.

A 34-year-old man was admitted to the hospital and intubated after a severe motor vehicle accident leading to multiple bone fractures two days ago. Despite weaning IV sedation, the patient continues to be unarousable to stimulation. An MRI was performed and DWI imaging is shown below. What is the most likely diagnosis?

A 75-year-old female with a past medical history of atrial fibrillation and hypertension presents to the ER with garbled speech. She seems unaware that her speech is nonsensical. On physical exam, she is unable to follow verbal commands but can understand visual cues. An ischemic injury is suspected. If this is true, a brain MRI would show which of the following areas of the brain is/are affected?

A 67-year-old man presents urgently to the emergency room with an acute onset of left-sided weakness and numbness. A CT head was performed and shown below. What is the most likely etiology of the patient’s symptoms?

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 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?

The brain MRI (susceptibility-weighted imaging) shown below is most likely associated with which of the following conditions?

A 32-year-old man with no significant past medical history presents to the emergency department after experiencing a generalized tonic-clonic seizure. His neurological examination was unremarkable. As part of his work-up, an MRI was obtained (see FLAIR axial image below). What is the most appropriate next step in management?

Which of the following medications has been shown to improve neurological outcomes in patients with subarachnoid hemorrhage?

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?

What is the pathophysiology of the lesion provided below?

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?

A 65-year-old male with a past medical history of diabetes, hypertension, and a 40-pack-year smoking history comes into the ED with an acute onset of ataxia, left facial numbness, right arm, and leg numbness, and dizziness. He also has intractable hiccups. A CTA angiogram shows the cause of the patient’s symptoms. Based on the clinical exam, which of the following arteries is occluded?

An 18-year-old male with a history of IV drug use was found unresponsive on a park bench by police. He was intubated by EMS and sent directly to the emergency room. The patient is comatose on examination. CT scan of the head is shown below. What is the likely diagnosis?

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

A 44-year-old woman who was recently started on a new abortive therapy for her migraines presents with a new type of headache described as more severe and with an extremely rapid onset. CT head imaging revealed no acute findings and lumbar puncture testing was unremarkable. Which of the following is the most likely diagnosis?

A 68-year-old right-handed male with HTN and atrial fibrillation formerly taking Eliquis, but stopped months ago due to GI bleed, presents for acute onset neurologic symptoms. He is able to understand speech and commands, however, he is unable to speak fluently and can not get the right words out. Despite this, he is able to accurately repeat words you say and correctly name items that are pointed to. What other neurologic symptom is also likely to be present on the exam?

What is the mechanism of action of clopidogrel?

A 41-year-old male presents to the emergency room with a two-day history of neck pain and speech difficulties. CT head shows scattered hypodensities in the left ACA and MCA territories. His Sagittal CT angiogram of the neck is shown below. What is the most likely cause of the patient’s symptoms?

A 45-year-old female with a past medical history of hypertension and medication non-adherence presents to the emergency department with weakness on the left side of the body and a drooping right eye. Her blood pressure is 220/100. On physical exam, her right eye is inferiorly and laterally deviated and the pupil is non-reactive. Her strength was 3/5 on the left side. MRI brain identifies an ischemic lesion. Based on the clinical exam, which of the following arteries is most likely the cause of the patient’s symptoms?

Which of the following findings is depicted in the vessel imaging shown?

Which of the following is not part of Gerstmann’s syndrome?

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

Identify the lesion below.

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

A 53-year-old male presents with a 3-month history of hypersexuality, visual agnosia, excessive chewing, and lip-smacking. Past medical history is notable for HSV encephalitis 6 months ago, which was treated with IV acyclovir. Based on the clinical history and examination, which of the following would most likely be appreciated on a brain MRI?

A 61-year-old male with hypertension, hyperlipidemia, diabetes, and coronary artery disease presents after a sudden onset of headache and difficulty speaking, with left arm and leg weakness. Their blood pressure is 212/105 mmHg, and their blood glucose is 275 mg/dL. You notice aspirin on his medication list. A CTH is performed and is notable for a 25 cc hemorrhage in the right basal ganglia. Which of the following is correct?

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 vessels drains into the sigmoid sinus?

A 78-year-old male with no past medical history presents to the ED with left-sided hemiparesis and slurred speech at 9 AM. She is unable to provide a clear clinical history. She was noted to be found at 7:30 AM in bed with the above-stated symptoms. Her husband states that the patient went to bed at 10:00 PM the previous night without any symptoms. CT head shows no blood or hypodensities, and CTA head/neck reveals a right MCA occlusion. Her NIHSS is 17. Which of the following treatment options is the most appropriate next step based on the available data?

An MRA is ordered for a patient presenting with an acute stroke. Based on the lesion appreciated in the image below (white arrow), what symptom is likely to be seen on examination?

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 7-year-old girl presents with 2 weeks of a right-sided unilateral throbbing headache. She has otherwise been healthy with no other symptoms and has no past medical history except for a light pink birthmark around her right eye. What is the most appropriate next step?

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 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 65-year-old female patient presents with right homonymous hemianopsia for the past week. She also says she has difficulty reading but no problems with writing. Which of the following area of the brain is likely affected?

Which of the following is the reversal agent for apixaban?

A 90-year-old woman presents to the emergency room with an acute change in mental status. On examination, she is alert but is not answering questions or following commands. Speech is fluent, but not interpretable. Comprehension is severely impaired. Interestingly she was able to repeat full sentences without much difficulty. Which of the following is the most likely territory of ischemic damage?

A 30-year-old male presents to the emergency room with weakness in his bilateral lower extremities. On arrival, he was hypertensive and bradycardic. 2/5 strength is appreciated in his bilateral lower extremities. A loss of pinprick sensation is also appreciated from his lower extremities, but proprioception and vibratory sensation are intact. These findings are most likely secondary to a lesion of which of the following blood vessels?

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?

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 critically ill 1-month-old has cerebral vessel imaging performed and shown below. Which of the following comorbid medical issues are likely present?

A 39-year-old male presents to the clinic for hallucinations. His medical history is only remarkable for a chemical accident at his job resulting in severe corneal scarring bilaterally, for which he now requires a seeing-eye dog.

His hallucinations are usually of tall figures dressed in black with long fingers. He is not frightened by this because he knows they are not real. He denies other neurologic deficits, denies auditory hallucinations and describes his mood as “good”. The rest of his exam is normal.

You are familiar with the underlying syndrome the patient is experiencing. You inform the patient that in the rest of the population the most common cause of this syndrome is actually…

What is the pathophysiology of the lesion provided below?

A patient with a recent history of ischemic stroke with almost no residual focal deficits except for a mild right-sided facial droop presents to the emergency room with altered mental status. Vital signs are only impressive for a low-grade fever. CT head and CTA show no acute changes when compared to imaging completed for his initial stroke. Blood work shows thrombocytopenia, anemia, and renal failure. A severe drug reaction is suspected. Which of the following medications is most likely the cause of this clinical presentation?

A 65-year-old male comes into the office with his wife for follow-up after a recent hospitalization for HSV encephalitis.  The wife says before his hospitalization, he used to be a quiet, shy man but recently has been making sexually inappropriate remarks to women at the park. The patient also has an increase in appetite and an urge to touch everything at the grocery store. Based on his cognitive deficits, which of the following areas of the brain is likely affected?

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

Which of the following medications is associated with the occurrence of reversible cerebral vasoconstriction syndrome (RCVS)?

Which of the following findings is depicted in the catheter angiogram shown?

A 19-year-old college student presents with an inability to look up at the board in class. On exam, he has upward paralysis but with preserved downward gaze. Pupillary accommodation is normal, but they remain dilated with the light shining. Where is the most likely location of the lesion?