Quiz 07/25/2022 (2)

Narcolepsy is associated with which of the following HLA alleles?

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

What is the benefit of using glucocorticoids in the treatment of bacterial meningitis?

The pathophysiology of the lesion shown in the gross pathologic image below is most likely which of the following?

A 56-year-old woman with a history of right temporal epilepsy with no other comorbidities had an ambulatory 24-hour EEG performed. What is the state of the patient in this segment of the recording?

An 8-year-old boy with no significant past medical history is brought to the clinic due to difficulties in school. His mother states that over the past year, she has received multiple phone calls from his teacher about his lack of concentration in class. On multiple occasions when asked a question, the patient would blankly stare at the wall and ignore the teacher, but then would return to his normal, talkative self immediately after each episode. An EEG is ordered, which shows 3 Hz generalized spike and wave discharges. The patient would most likely benefit from a medication targeting what?

Based on the histopathologic findings shown below, how long ago did this patient experience an ischemic stroke?

Identify the pathological abnormality shown in the image below.

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?

A 26-year-old female with a past medical history of pulmonary embolism presents with seizures and left-sided weakness. She had been complaining about a headache for the past week. An MR venogram is shown below. Which of the following is the next best step in management?

Which of the following medications is effective in the treatment of myotonia?

A 27-year-old previously healthy female is seen at the clinic for 5 days of leg weakness. The weakness has progressively been getting worse and now she has difficulty rising from a chair. Her past medical history is unremarkable except for a few days of an upset stomach and diarrhea that occurred two weeks ago. On physical exam, strength is diminished in the bilateral lower extremities. Deep tendon reflexes are 1+ in the lower extremities. A lumbar puncture is ordered. Testing of the cerebral spinal fluid (CSF) in this patient is most likely to show which of the following?

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

A 64-year-old man with idiopathic Parkinson’s disease being treated with carbidopa-levodopa is experiencing significant wearing-off despite increasing frequency and dose of levodopa-carbidopa, which is now producing significant peak dose dyskinesia. Which of the following would be a reasonable next agent to prescribe to reduce this wearing-off effect?

A 6-year-old developmentally normal male presents after experiencing an episode of jerking of the right side of his mouth and inability to speak lasting 2 minutes. The patient is now back to baseline and has an EEG performed. Based on this clinical picture, which of the following abnormalities would you most expect to see on the EEG?

A 55-year-old male with a recent history of losing 50 pounds after gastric bypass is referred to the EMG lab with difficulty walking. He has noticed that his left foot drags occasionally causing him to trip and that he has numbness on the top of his left foot up to the middle of his shin. Which of the following statements is the most accurate based on the EMG findings shown below?

A 57-year-old male presents to the Emergency Room with a 3-month history of progressive altered mental status. On examination, the patient had ataxia and hyperekplexia. An MRI is performed and shown below. What is the most likely etiology of the patient’s deficits?

A 24-year-old male presents to the clinic with numbness in the hands and feet. He has been experiencing these symptoms since his late teens, but the numbness has gotten progressively worse. Additionally, he has been stumbling and losing his balance more frequently in the past 18 months, and he received a new pair of glasses because he was having trouble with his vision at night. On physical exam, he has decreased sensation to vibration and pinprick in his bilateral lower extremities and palpable, enlarged nerves. Laboratory studies reveal an elevated level of phytanic acid. What is the most likely diagnosis?

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?

Primary generalized dystonia is a genetic disorder that can be seen secondary to a mutation of which of the following genes?

A 54-year-old male with hypertension, hyperlipidemia, and atrial fibrillation on warfarin is newly diagnosed with epilepsy. Of the following medications, which is the most appropriate anti-seizure medication to prescribe?

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?

Oculomotor nerve palsy is most likely to be seen secondary to an aneurysm in which of the following arteries?

You are caring for a 50-year-old with amyotrophic lateral sclerosis (ALS). Which of the following disorders is most likely to also develop in patients with ALS?

A 56-year-old male comes to the clinic with a burning and tingling sensation in his feet and hands for the past 4 months. He has a history of morbid obesity and underwent gastric bypass surgery last year. On physical exam, he has 3+ ankle and patellar reflexes. He also has a positive Babinski and positive Romberg sign. There is impaired position and vibration sense in his big toe bilaterally. This patient’s condition is most likely due to a deficiency of which of the following?

Which of the following structures is supplied by the recurrent artery of Heubner?

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

Identify the pattern seen in the 5th second of this EEG recording.

A 5-year-old male presents because of muscle stiffness. His symptoms are worse during the colder winter months and with gym class at school. He sometimes becomes so stiff he can hardly breathe. Examination shows no muscle atrophy or hypertrophy but myotonia is present. Upon further questioning, you learn he has an older brother with similar symptoms. What is the likely dysfunctional gene in this patient?

Which of the following medications is the first-line treatment for trigeminal neuralgia?

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

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 patient recently diagnosed with multiple sclerosis was started on an oral disease-modifying therapy (DMT) that works on nuclear factor erythroid-derived 2-related factor (Nrf2)-dependent and independent pathways. One week later they call you complaining of flushing of the skin. What is the most appropriate next step in management?

Pilocytic astrocytomas characteristically have which of the following genetic abnormalities?

A 10-year-old female from the northeastern United Stated presents to the ED with her mother after a one-week history of difficulties in school and difficulties with speech. Her mother states that two weeks ago the patient had a rash on her leg and viral-like symptoms that went away within a few days. Then, this past week the patient’s teacher reported that she was having difficulties with attention in school and was performing very poorly on assignments. Her mother also confirmed that the patient has been more forgetful and is also slurring her speech. An MRI of the brain was performed and it showed multifocal white matter lesions. Of note, the patient likes to spend a lot of time outdoors and recently went on a camping trip. Which of the following is the most likely cause of the patient’s symptoms?

A 32-year-old obese and pregnant female in her third trimester presents to the clinic with pain and tingling of the lateral thigh with occasional aching in the groin. It is worsened by moving to a standing or sitting position and by wearing tight underwear. She has numbness on the right anterolateral thigh up to the level of the hip. The strength exam is normal. Which nerve is likely affected?

A 32-year-old Chinese male is referred to the epilepsy clinic after experiencing two episodes concerning for possible seizures. The first episode was unwitnessed, but the patient states that there was an abrupt loss of consciousness and that he woke up with the side of his tongue bitten and generalized myalgias. The second event was witnessed by his wife who noticed one day that the patient was unresponsive and lip-smacking for 2 minutes before returning back to baseline. MRI brain was performed and showed left-sided mesial temporal sclerosis. Which of the following medications should be avoided for this patient?

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

The pathology seen in the image below is most likely related to maternal use of which of the following medications?

A 30-year-old female with no known past medical history comes to the emergency room after a generalized tonic-clonic seizure. Her friend says that she has been behaving oddly over the past couple of days and has been complaining of a headache. An axial T2 brain MRI is shown below. Which of the following is the most likely diagnosis?

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

A 38-year-old female presents for 5 weeks of worsening encephalopathy, and blurred vision. An MRI Brain with contrast is performed and shown below (T1 post-contrast, multiple axial sections). Of the following, what is the most likely diagnosis?

A 50-year-old male is admitted for 3 months of progressive memory loss, visual hallucinations, and myoclonus. Examination revealed myoclonic jerks. Which of the following tests is the most specific for this disease?

A 31-year-old female who recently delivered a healthy boy 3 days ago comes into the emergency room with a headache and vomiting. Other than requiring an epidural for pain management, the delivery of her child was uncomplicated. Her neurological exam is normal. A brain MRI was completed and is shown below (Left: T1, Right: T2 with contrast). Which of the following is the most likely diagnosis?

The axial T2 brain MRI image shown below is from a 20-year-old man who presented to the hospital after experiencing a motor vehicle accident. Which of the following associated findings would be expected given the abnormality shown?

A morbidly obese patient with a past medical history of brainstem stroke and excessive daytime sleepiness undergoes polysomnography. Polysomnographic testing revealed an average of 8-10 apnea/hypopneas per hour during sleep. During prolonged periods of apnea, there were no out-of-phase movements on plethysmography. Which of the following is the most likely diagnosis?

Which of the following nuclei of the hypothalamus is involved in temperature regulation?

A 28-year-old patient who you just diagnosed with non-epileptic spells admits to insomnia, low energy, increased appetite, loss of interest in activities he used to enjoy, and difficulty concentrating. Additionally, he endorses periods of pressured speech, racing thoughts, easy distractibility, and delusions of grandeur. Despite these symptoms, he continues to fulfill the duties of his high-paying job. In addition to non-epileptic spells, he also carries a diagnosis of which of the following?

Which of the following is not a known side effect of chronic phenytoin use?

A 59-year-old man with HTN, T2D, and peripheral vascular disease presents with sudden complete loss of vision in the left eye, which resolved after about 20 minutes. He denies any other symptoms. Which of the following vessels was most likely obstructed?