Quiz 07/24/2022 (1)

Occlusion of the vessel labeled 1 in the angiogram below would lead to which of the following symptoms?

Which of the following is not a risk factor for carotid dissection?

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

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?

The vessel imaging shown below is consistent with which of the following?

A young infant is found after birth to have an abnormality of the left arm. The arm is held down by the infant’s side, adducted and medially rotated, and the forearm is extended and pronated. What is the anatomic location of the injury causing the deficits?

An 80-year-old woman with a history of well-controlled Parkinson’s disease presents with worsening movements at night. Her husband states that she often punches and yells during her sleep. Some of these movements have been so dramatic that she punched a hole in the wall beside her bed. Melatonin was tried but did not lead to a significant improvement in symptoms. Which of the following is the most appropriate next step in treatment?

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

A 66-year-old patient with bradykinesia, hypomimia, dementia, postural instability, cogwheel rigidity, shuffling gait, and resting tremor presents to your clinic. He has been on carbidopa/levodopa for several years, which has helped, but now his wearing-off phenomenon is becoming more frequent despite attempted medication adjustments. He asks about deep brain stimulation (DBS).

Which of the following is a contraindication for DBS in Parkinson’s disease (PD)?

A 55-year-old male with a 3-year history of postural hypotension, incontinence, and ataxia comes to the clinic for evaluation. An MRI brain shows degeneration of the pontocerebellar and olivocerebellar fibers. What 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?

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

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

A 62-year-old woman presents to your clinic with complaints of dizziness. She states that about 2 weeks ago she had some dental work done including a root canal, and ever since then has had spells of extreme dizziness. She describes that the room spins and she becomes sick to her stomach. The sensation is improved by sitting very still. It completely resolves in between episodes, and episodes happen about once or twice a day. She noticed that it happens consistently when she tries to back out of the driveway in the early morning. She had a CT head one day ago that was read as normal. On exam, she has inducible nystagmus. The otoscopic exam is normal. Which of the following is the most accurate statement?

Which of the following cranial nerve(s) transverses through the structure (blue arrow) shown below?

A 2 month-old female is brought to the emergency room by her mother after she noticed abnormal movements concerning for possible seizure. The child was born at term and was the product of a normal pregnancy and delivery. While gathering a history, the child is lying on the bed still when you notice repetitive movements of his bilateral lower limbs. When her mother notices she picks up the patient and the movements resolve. What is the most likely diagnosis?

A 71-year-old female with a past medical history of hypertension presents to the clinic with a 1-year history of a progressive right tremor. She only notices the tremor when she is sitting still. On physical exam, you notice that her movements are not smooth, and she seems rigid in her extremities. She also demonstrates a slow, shuffling gait. This patient’s condition is most likely due to the loss of which neurotransmitter?

Which of the findings are most likely to be found on examination in a patient with the lesion appreciated in the image below?

Which answer correctly identifies all of the cranial nerve(s) that transverse through the structure (blue arrow) shown below?

Which of the following direct dopamine agonists are the most effective in the management of severe “off” phenomenon related to chronic levodopa use in the management of advanced Parkinson’s disease?

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?

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

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 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?

A 7-year-old boy was brought to the ED by his mother for a three-week history of involuntary movements. He was initially seen by his pediatrician two weeks ago. MRI of the head was performed and was unremarkable. Methylphenidate was trialed for a presumed tic disorder but it had no benefit. The Movements resolve with sleep. On examination, he has difficulty controlling facial and extremity movements as well as maintaining tetanic contraction of his hands. There was also a newly appreciated cardiac murmur. What is the most likely diagnosis?

Which of the following syndromes are most likely associated with the lesion shown in the image below?

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?

What is the anatomical structure labeled “C” below?

A 4-year-old male is brought to your clinic by his father who states that he has been experiencing random jerky movements of his arms and his neck for the past year. His father states that the jerky movements have not gotten worse over time but tend to appear more when the boy is agitated or under stress. The movements cease when he is asleep. The patient has otherwise been meeting all of his developmental milestones. Genetic testing reveals a mutation in TITF1, a thyroid transcription factor. What is the diagnosis?

Which of the following structures is well myelinated in a full-term (40-week) infant?