Quiz 07/25/2022

A 57-year-old navy veteran with a history of PTSD presents with a 2-year history of progressive, asymmetric weakness. The patient states that symptoms started in his left arm. Six months later he started to have falls due to tripping over his right foot. His neurological examination shows weakness of the intrinsic hand muscles of the left arm, ⅖ strength on dorsiflexion of the right ankle, and no sensory disturbances. Reflexes were mute in the left upper extremity and there were several beats of clonus at the right ankle. Fasciculations were present in the tongue, right gastrocnemius, and left tibialis anterior. An EMG is recommended for diagnosis. Which of the following EMG findings are most likely seen in this patient?

Gaucher disease is caused by a homozygous mutation in the GBA gene which encodes the enzyme beta-glucocerebrosidase. Which of the following neurologic disorders is also linked to mutations, both homozygous and heterozygous, in the GBA gene?

Which of the following clinical features is most suggestive of logopenic primary progressive aphasia?

The abnormalities appreciated on the MRI below are due to a defect in which of the following processes?

A 13-year-old boy presents with worsening severe headaches, nausea, vomiting, sleepiness, and confusion. The symptoms have been episodic, improved somewhat by lying recumbent. An MRI is done and shows the following. Which of the following is the best treatment option?

A 68-year-old man with left leg weakness and pain has an MRI performed to evaluate for a possible etiology. Her imaging is provided below. Based on the location of the lesion, which of the following muscles is most likely weak on examination?

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

A 28-year-old caucasian male was last seen well at 9:00 AM when he got into a verbal argument with his girlfriend. When the girlfriend returned from work at 5:00 PM, she found the patient on the floor of the garage altered, and states he “smelled unusual”. In the emergency department, the patient is disoriented but arousable with much effort. He complains of a headache and blurred vision, and he appears uncomfortable with a respiratory rate of 40. You send stat labs and they are listed below. What treatment should you administer immediately?

ABG: 7.18 pH, PCO2 = 28, PO2 = 118
Electrolytes: Na 135 mEq/L, K 5.0 mEq/L, Cl 105 mEq/L, HCO3 15 mEq/L

A patient with newly-diagnosed early state amyotrophic lateralized sclerosis (ALS) presents to your multidisciplinary clinic for the first time. After discussing the effectiveness and side effects of riluzole and endavarone, the patient informs you that he doesn’t want to start either medication. Which of the following basic principles of medical ethics could be best applied to this scenario?

What is the pathophysiology that leads to the pathology shown with a black arrow in the image below?

An 80-year-old woman with uncontrolled HTN presents to the ED with symptoms upon awakening of left hemi-sensory loss, last seen well 8 hours prior. MRI is done and shows a lateral thalamic lacunar stroke. The small branch affected in this lacune is most often a branch of which major artery?

A 47-year-old former football player with a history of diabetes and hypertension presents to the EMG lab with left upper extremity weakness and pain. Motor and sensory nerve conduction studies were normal. An EMG was performed and shown below. What is the most likely diagnosis?

A 24-year-old healthy male with recent right-sided otitis media complicated by mastoiditis presents to the ER with a first-time seizure. On examination the patient is somnolent and febrile, MRI brain shows a right temporal lobe intraparenchymal mass with a solid rim of contrast enhancement and surrounding vasogenic edema, what is the most likely etiology?

A 37-year-old man with a history of hypertension presents to the emergency department with a one-day history of difficulty walking. On examination, he has right leg paresis and hyperreflexia with a right-sided Babinski response. His non-contrast axial CT scan is shown below. Which of the following is the most likely etiology of this patient’s symptoms?

Which of the following is seen on muscle biopsy in patients with steroid myopathy?

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

An 83-year-old male with a past medical history of PD is brought to the clinic with his daughter due to worsening behavior at his nursing home. He has become easily agitated with staff and will occasionally yell out at night at “people trying to rob him”. His daughter asks which treatments could be used to help with these symptoms. Which of the following antipsychotic agents would be the best treatment options?

A patient with a clinical history concerning for hydrocephalus has an MRI brain completed (see below). Surgical resection was completed and genetic analysis revealed no presence of an IDH mutation or 1p/19q co-deletion. What is the most likely diagnosis?

Which of the following comorbidities are responsible for the lesion appreciated in the image below?

Which of the following is the best prognostic finding on EEG after cardiac arrest?

Which of the following embryologic derivatives myelinates the peripheral nervous system (PNS)?

Which of the following is the mechanism of action for aducanumab?

Which of the following medications requires blood pressure and pulse monitoring for at least 6 hours after the first dose to assess for first-dose-related bradycardia?

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

A 42-year-old woman with major depressive disorder and anxiety who has recently completed treatment for gambling addiction presents with a unilateral upper extremity resting tremor and the feeling that she is “stiff all of the time”. Her husband remarks that she has become much more soft-spoken lately and that five years ago she began acting out her dreams. Which of the following medications should be avoided in this patient?

A 27-year-old woman comes into the clinic with the chief complaint of low energy and depressed mood. Ever since her mother died 3 years ago, she has felt fatigued and does not want to socialize with friends or family. She has had a poor appetite and has lost over 15 pounds in the past year. Additionally, she dropped out of college earlier this year due to difficulty concentrating on her studies. Which of the following is the most appropriate diagnosis?

Fibrillations and positive waves are first seen on electromyography (EMG) at which point following a nerve transection?

A 62-year-old male with a past medical history of hypertension, type 2 diabetes, and dyslipidemia presents with a stepwise progression of worsening forgetfulness over the last three years. Physical examination reveals a score of 20/30 on the Mini-Mental State Examination with deficits in multiple cognitive domains. Hyperreflexia in the left upper and lower extremities is also appreciated. Her axial FLAIR sequence brain MRI scan is shown. Which of the following is the most likely diagnosis?

A 45-year-old patient presented to the emergency room unresponsive. Emergency medical services noted that the patient was found in his garage with the car running in an apparent suicide attempt. Despite appropriate medical care, the patient passed away. An autopsy was performed. A gross pathology image is shown below. Identify the following regions marked by the white arrows.

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?