Quiz 07/26/2022 (2)

A 55-year-old was recently diagnosed with breast cancer. She required a right mastectomy, lymph node resection, and local radiation. She presents to your clinic with right arm pain and weakness. On exam, she has weakness only to forearm pronation, and flexion at the wrist and biceps. She also has numbness of the lateral hand and the first 3 digits.

Which cord or nerve was likely injured from the surgery or radiation?

Which of the following arteries supplies the head of the caudate nucleus and the anterior limb of the internal capsule?

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

A 60-year-old female with a past medical history of chronic alcohol use was admitted to the hospital 4 days ago for community-acquired pneumonia. Over the last 48 hours, the patient developed severe encephalopathy and generalized weakness. An axial T2 FLAIR MRI is shown. Which of the following is the most likely diagnosis?

Lesion to which area of the brain causes impairment in naming, fluency, and repetition with intact comprehension?

Which of the following does this EEG tracing reveal?

Deep brain stimulation has been FDA approved for the management of medically refractory epilepsy when it targets which of the following structures?

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

A 78-year-old male with a past medical history of diabetes presents to the clinic with a 2-year history of progressive lower extremity numbness and pain. He describes the pain as “pins and needles”. Physical examination reveals loss of pinprick sensation to the ankles bilaterally, mute Achilles reflexes, and moderate difficulty with tandem gait. A diagnosis is made based on examination and clinical history. What is the mechanism of action of the most appropriate first-line therapeutic agent?

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 female with a history of cataracts and an unknown family history was referred to the neurology clinic for excessive daytime sleepiness. On examination facial weakness and grip myotonia were appreciated. Genetic testing revealed a mutation in the DMPK gene. Based on her diagnosis, which of the following tests should be performed annually?

A 6-year-old male with a history of medically-refractory epilepsy (on three anti-seizure medications), and right-sided-hemiparesis, presents to the emergency room with a three-day history of continuous right facial twitching. Symptoms persist during sleep and have not responded to benzodiazepines. On examination, the patient has retained awareness despite the continuous facial movements. MRI brain was performed and shown below. Of the following, which is the most appropriate therapy to achieve seizure freedom?

A previously healthy 25-year-old female presents to the emergency room with lower extremity weakness, numbness, and urinary retention. Lower extremity hyperreflexia and a sensory level at T10 were appreciated on examination. A contrasted cervical/thoracic and lumbar MRI was performed and shown below. Lumbar puncture was performed after imaging was completed and showed an elevated protein concentration, normal glucose, 3 WBCs, and oligoclonal bands. Rheumatologic studies are negative. Based on the most likely diagnosis, what is the most appropriate next step in medical management?

Which of the following is the antibody associated with dermatomyositis that is known to confer the highest risk of cancer?

This brain biopsy is consistent with which of the following pathologies?