Quiz 07/24/2022 (1)

A 42-week gestational age female was born vaginally to a mother with a history of type 2 diabetes. Delivery was complicated by shoulder dystocia and required assistance with forceps. Apgar scores at 1 and 5 minutes were seven and nine, respectively. Her birth weight was 9 pounds and 6 ounces. Examination after birth showed there was no appreciable left arm bicep or deltoid function. What is the most likely etiology for this finding?

A 72 y.o. female presents to the clinic with complaints of decreased interest in eating, and has lost weight. She states foods have an unusual taste and are not appealing. On detailed examination, she is found to have normal extraocular movements, normal facial muscle symmetry, and normal facial sensation and swallowing. On further detailed examination, she has a loss of taste sensation in the right anterior two-thirds of her tongue. Of the following, which is the most likely area of injury?

Which of the following is the most appropriate initial screening test for suspected restless leg syndrome?

What anatomical structure is the most common location for a Mycobacterium tuberculosis-related CNS infection?

A patient with a past medical history of Parkinson’s disease is brought to the emergency room with the chief complaint of a severe headache, chest pain, and shortness of breath. His blood pressure on arrival was 196/122 mmHg. The patient states that he was in his usual state of health earlier in the day but started feeling unwell after attending a wine and cheese pairing event at a local winery. Which of the following medications is likely the cause of the patient’s symptoms?

The following is a sample of gray matter stained with Anti-NeuN and viewed under a low-power microscope lens. The pathology marked by the blue arrow is most consistent with which of the following causes of epilepsy?

What is the state of the patient in the EEG shown below?

A 69-year-old male presents to the clinic with his wife who states that for the past 10 months the patient has become increasingly slow and more clumsy with daily activities. He has also been complaining of dizziness, especially in the morning when he first gets out of bed and has fallen once in the past month. On physical exam, it is observed that the patient has a 21 mmHg drop in systolic blood pressure when going from a sitting to a standing position. A brain MRI is ordered and shows a cruciform hypointensity in the pons. What is the most likely diagnosis?

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

This muscle biopsy is most consistent with which myopathic disease?

A 40-year-old textile worker is brought to the clinic for slowly progressive symptoms including shuffling gait, tremor, and profuse drooling. On examination, his speech is difficult to understand and there is cogwheel rigidity in his arms and legs. His tremor is most evident when his limbs are at rest. Exposure to which of the following is the most likely cause of the patients’ symptoms?

Which of the following medications used in the management of attention deficit hyperactivity disorder (ADHD) can worsen comorbid Tourette syndrome if present?

A 20-year-old male presents to your clinic for weakness. He is the star baseball player at the local university, but during the season his batting average has been dropping, and he finds he is having trouble standing on his toes, performing overhead shoulder presses, and more recently ascending steps. You give him a script for some blood testing and an EMG/NCS and schedule a follow-up in 2 weeks.

Unfortunately, shortly after returning home he had a fall down a flight of stairs and sustained a compound radius fracture. He was taken to the emergency room where an open reduction and fixation (ORIF) was performed. Shortly after the surgery, he developed tachycardia, tachypnea, and masseter muscle contractions, which then progressed to fever and rigidity.

Which of the following test results is most likely to be seen in this patient?

Which of the following is NOT known to cause a drug-induced tremor?

Which of the following cranial nerves is most likely to be affected by increased intracranial pressure?

Patients with neurofibromatosis type 1 (NF1) classically have which of the following associated with their disease?

A 30-year-old woman has visual evoked potentials performed that show a right eye P100 latency of 140 msec and a left eye P100 latency of 103 msec. Which of the following is the most likely cause?

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

Which of the following symptoms seen with normal pressure hydrocephalus (NPH) is the most responsive CSF shunt placement?

Which of the following medications, when taken alongside statin therapy, increases the risk of statin-induced myopathy?

Cool limbs during a nerve conduction study will have which of the following effects on the data recorded?

Alzheimer’s disease typically has which of the following findings on functional PET imaging?

A 34-year-old female with a history of chronic daily headaches had an MRI performed as part of her workup. Her imaging is shown below. What is the likely etiology of the lesion shown?

A 4-year-old boy with a history of mild cerebral palsy comes to the clinic for his annual follow-up. Since last seen in the clinic the patient and family have noted that he has been having increased difficulties with his left leg. Most days he is able to ambulate with a hand-held mobility device. However, more recently family has noticed that he not walking as much as he used to. On examination, there is increased spasticity and hyperreflexia at the ankle. The right leg had normal strength and tone. What is the most appropriate therapy for the patient’s symptoms?

A 35-year-old male with a history of intravenous drug use was found unresponsive with a used syringe at his side. After 30 minutes of CPR, there was a return of spontaneous circulation. A CTH was performed (shown below). Which of the following is appreciated on imaging?

A 40-year-old male with a history of headaches, seizures, and recurrent strokes has a brain biopsy performed to aid in diagnosis. Electron microscopy of his brain tissue shows granular osmiophilic material in the basal lamina of small cutaneous arterioles. What is the cause of this patient’s disease?

A 16-year-old girl is seen in the clinic for episodes concerning for seizures. Episodes are characterized by staring off, unresponsiveness, and licking her lips for 30 to 60 seconds. Two weeks ago one of these episodes developed into a generalized tonic-clonic seizure. That day she went to the emergency room and had an MRI performed. The associated images are shown below. Based on the clinical history and imaging what is the most likely diagnosis?

Parents bring their 3-year-old son to the clinic for difficulty walking. On examination, the patient has a waddling gait and enlarged calf muscles. When rising from a seated position he has to rely extensively on his arms to stand up. Which of the following is the most likely inheritance pattern of the genetic disorder affecting this patient?

A 38-year-old man with a prolonged history of intravenous drug use, HIV, and poor compliance with HAART therapy is brought to the hospital by police after being seen wandering across a busy street intersection. His last CD4 count was 180 cells/microliter 8 months ago. Vitals appear within normal limits on arrival. Neurological examination shows inattention, poor short-term memory, and difficulties with abstract thought. An MRI is performed and shown below. What is the likely etiology of his symptoms?

Which of the following is the thalamic relay center for auditory stimuli?

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?

A 55-year-old female with a past medical history of coronary artery disease and ischemic stroke with residual mild left arm weakness presents with headaches for a year. Episodes occur two to three times a month. The pain is unilateral and is associated with nausea and photophobia. During this episode, she is unable to go to work and over-the-counter anti-inflammatories have been ineffective. Physical exam and vitals are normal. Which abortive therapy is the most appropriate next step in management?

A full-term male is having a routine awake and sleep EEG performed because of episodes concerning for possible seizures. These episodes were first noticed four days after an uncomplicated vaginal delivery. On the video EEG recording, you notice a violent jerking of the limbs followed by sustained stiffening after a phone rings loudly in the room. What is the most likely diagnosis?

A 19-year-old female with a past medical history of anorexia and insomnia presents with major depressive disorder. Which of the following medications is the most appropriate at this time?

A 6-month-old male is admitted to the ED for acute respiratory failure. On examination, he has generalized weakness, diffuse hypotonia, and areflexia. He was admitted to the pediatric Intensive Care Unit and intubated. A chest X-ray showed a narrow chest. EMG/NCS was performed showing axonal motor polyneuropathy with tongue fasciculations and signs of chronic denervation. What is the most likely pathologic etiology causing this presentation?

The anatomical structure identified in the image below (blue arrow) derives from which of the following embryonic tissues?

A 30-year-old woman presents to the clinic with severe headaches requesting treatment because she “can’t live with this pain”. Episodes are left-sided, occur multiple times a day, and last about 20 minutes each. During episodes, she will also have eye tearing and rhinorrhea. What is the correct diagnosis?

Patients with Von-Hippel Lindau (VHL) syndrome are at risk of developing which of the following?

Which of the following nerve conduction study abnormalities is least likely to be seen during the initial phase of acute inflammatory demyelinating polyneuropathy (AIDP)?

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