Quiz 07/27/2022

A 50-year-old Caucasian woman with no past medical history is admitted to the psychiatric hospital after trying to jump from a moving bus. She reports the other passengers were laughing at her in their minds, and trying to steal her thoughts. Upon arrival to the psychiatric floor, she is witnessed to have sudden left eye deviation with right arm twitching for a few seconds before turning her head, screaming loudly, and falling to the floor with full-body convulsions, lasting 2 minutes.

You, the attending neurologist, are consulted to help evaluate. On exam she is easily distractible, looking to the corners of the room for security cameras. You contact her husband who states she has never had any problems like this before, but she has gone downhill over the last 3 weeks, forgetting people and places, repeating herself, and acting strangely.

Lab evaluation reveals normal CBC, BMP, TSH, T4, free T4, and T3. The comprehensive drug screen is negative. MRI brain w/ and w/o contrast is normal appearing. Lumbar puncture is with 18 cmH20 opening pressure, 0 WBCs, 1 RBC, 50 protein, and 55 glucose. The autoimmune panel is sent and anti-microsomal antibodies are elevated. What is the most likely diagnosis at this time?

An 8-year-old boy is brought to the neurology clinic due to an 18-month history of repetitive, involuntary movements of his face and body. His mother states that he has been bullied at school because of it, which is causing him significant distress and anxiety. His birth history and developmental history are normal. On physical exam, the patient has excessive blinking and occasionally jerks his right shoulder upwards at rest. The physical exam is otherwise within normal limits. which of the following is the most likely diagnosis?

Which of the following antiepileptic drugs can induce myoclonic seizures?

Which of the following structures is not primarily involved in the processing and relay of auditory information in the central nervous system?

A 64-year-old woman is brought to the office by her husband for changes in her speech pattern. While neurocognitive testing was largely unremarkable, her spontaneous speech appears effortful, halting, and laced with grammatical errors. MRI of the brain revealed left posterior frontal and insular atrophy. Which of the following is the most likely diagnosis?

A 33-year-old woman has recently given birth to a healthy 3-month-old boy. She has been complaining of poor sleep for the past year, mainly from an uncontrollable urge to move her legs that is only relieved by moving them. This is present during the day to a small degree but is much worse at night and during periods of rest. What would be the best test to order for her?

A 45-year-old man comes into the ED complaining of a severe headache. A spinal tap shows xanthochromia. The patient is treated immediately and spends the next two weeks in the neurocritical care unit. On day nine of his stay, his speech becomes slurred and the neurologist notices that the left side of his face is drooping. What is the class of drugs that could have potentially prevented these findings?

An EMG/NCS is performed for the evaluation of subacute left upper extremity weakness in an adult female. There are fibrillation potentials in the deltoid and biceps on EMG and decreased median and radial sensory amplitudes on NCS. Which portion of the brachial plexus was injured?

A 21-year-old female was admitted to the hospital with a 3 weeks history of progressive lower extremity weakness. An EMG was performed and the results were shown below. Based on the clinical history, examination, and diagnostic testing, the patient was started on plasma exchange (PLEX) therapy. After completing her PLEX therapy there was a marked improvement in her weakness. Although not shown below, which of the following additional NCS/EMG results were also likely present on the day of recording?

Which of the following is most strongly associated with an increased risk of seizure recurrence after a first unprovoked seizure?

A study published in 1992 indiscriminately assigned 457 patients with optic neuritis to receive either 14 days of oral prednisone, 3 days of intravenous methylprednisolone followed by 11 days of prednisone, or an oral placebo for 14 days as an acute therapy. Visual function testing was performed intermittently over a six-month follow-up period. The results showed that patients who received methylprednisolone followed by oral prednisone had a faster rate of visual recovery. What type of study design was this?

A 45-year-old male with a history of C6 radiculopathy presents to the neuromuscular lab for electromyography. The video below depicts spontaneous findings while evaluating the biceps brachii muscle during electromyography. What is the abnormal pattern shown?

A 49-year-old male presents with numbness and tingling of the right hand. A median nerve conduction study is completed and shown below. Which of the following is the correct interpretation of its results?

A 26-year-old male suffered a spinal cord injury after falling from a ladder while hanging Christmas lights. In the ICU, he is experiencing episodes of sudden extreme increases in blood pressure, bradycardia, and diaphoresis. This condition is seen most commonly in lesions of which spinal cord levels?

A 57-year-old woman with a past medical history of hypothyroidism was referred to the EMG lab with a one-year history of right-hand numbness. Based on the EMG data shown below, what is the most appropriate next step in medical management?