Quiz 07/28/2022

A previously healthy 14-year-old female presents to the emergency room after experiencing a trip and fall where she hit her head. She returns to baseline, but out of caution a CT head and subsequent MRI brain are performed in the ED. What is a potential complication caused by this lesion seen in this MRI?

Brain metastases are most likely to have arisen from which primary source?

Bilateral exotropia is typically seen with which of the following lesions?

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?

A 45-year-old female who is a professional pianist was referred to the EMG lab for right-hand numbness and tingling. Based on the EMG data outlined below where is this patient’s pathological lesion?

A 68-year-old female presents with a one-year history of progressive memory problems and deteriorating mobility. Upon further questioning the patient notes incontinence. A physical exam reveals a wide-based gait with shuffling steps. A brain MRI shows widening of the temporal horns of the lateral ventricles. Which of the following is the best next step in management?

Which of the following is the relay center for sensory information of the body?

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

While on the consult service you are called to see a patient from the surgical ICU whose hospital course has been complicated by a prolonged episode of ventricular tachycardia and hypoperfusion. After a return to spontaneous circulation, an MRI is performed due to concerns for ischemic stroke. MRI shows bilateral parietal-occipital hyperintensities on diffusion-weighted imaging consistent with watershed infarcts. Once he recovers from his cardiac event, what neurologic symptoms would you expect based on the MRI findings?

A 28-year-old male with a known history of neuromyelitis optica spectrum disorder (NMOSD) and a recent diagnosis of acute optic neuritis returns to the emergency room for worsening monocular vision loss despite completing 5 days of high dose (1 gm/day) methylprednisolone therapy. Based on the clinical scenario and level of evidence for efficacy, what is the most appropriate next step in therapy?

A 36-year-old woman was recently started on natalizumab for management of her multiple sclerosis. Over the next several months, she develops progressive weakness, incoordination, and speech disturbances before passing away six months after initiating natalizumab. Testing for which of the following pathogens should have been performed prior to natalizumab initiation to prevent this outcome?

A 4-month-old boy is brought by his parents due to difficulty in feeding, and episodes of apnea. Physical examination reveals tongue fasciculations, a bulging anterior fontanelle, and an abducens nerve palsy. MRI reveals an Arnold Chiari malformation type II. What additional defect is this child likely to have?

A 38-year-old male with a history of sarcoidosis and a one-week history of subacute onset of progressive weakness was admitted to the hospital with difficulty ambulating. On examination, you appreciate bilateral lower extremity weakness and hyporeflexia. Based on the clinical history and EMG findings shown below what is the most likely diagnosis?

The trochlear nucleus sends nerve fibers to which of the following muscles?

389 Patients who had acute unilateral optic neuritis were enrolled between 1988-1991 in a study and followed for 15 years to assess their risk for developing multiple sclerosis (MS). They found that the probability of developing MS within 15 years was 50%. What type of study was this?

Which of the following is the first abnormal EMG/NCS finding seen in a patient with carpal tunnel syndrome?

Which of the following medications is an NMDA receptor antagonist?

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 27-year-old woman comes to the clinic for a routine checkup. She appears shy and does not make much eye contact. She mentions that she doesn’t have many friends because feels like she doesn’t deserve them and is fearful of rejection. She has had some depressive episodes in the past, but “does not want to bother anyone” about it. Which of the following is the most likely diagnosis?

At a national conference, a pharmaceutical representative reaches out to you and offers you an all-inclusive trip to the Bahamas to hear about their newest available preventative migraine therapy. As a resident, which is the most appropriate response:

A 30-year-old female with a past medical history significant for acne, migraine without aura, and depression presents to the emergency room with severe recurrent headaches. She says the headaches come on quickly and only last a couple of minutes but are debilitating. CTH was normal. A CTA head and neck was performed which showed segmental artery narrowing in the proximal MCA territory. Which of the following medications was the most likely trigger of this patient’s presentation?

A 27-year-old presents to the clinic with finger extension, wrist extension, shoulder abduction, and shoulder adduction weakness. There is also numbness along the lateral and posterior arm. Which of the following is the most likely cause of the patient’s symptoms?

Which of the following infectious agents is most likely responsible for the pathology seen in the image below?

A 37-year-old female with a past medical history of acne, obesity, anxiety, and fibromyalgia presented to the emergency room with a severe headache, papilledema, and visual disturbances. MRI shows an empty sella and MRV was normal. Symptoms started two weeks after her primary care physician initiated a new medication. Which of the following was the most likely medication initiated by the primary care physician?

A 1p/19q co-deletion is associated with which of the following tumors?

A 27-year-old man presents after having an unprovoked generalized tonic-clonic seizure. Which of the following should he be told regarding his clinical situation?

Which of the following brain metastases has the highest risk of intracranial hemorrhage?

A 24-year-old woman presents to the ER with a one-day history of diplopia. On examination, the patient has right internuclear ophthalmoplegia. On further discussion, she describes an episode of left lower extremity numbness about 2 years ago that resolved after a few weeks on its own. An MRI of her brain and spinal cord was ordered. Findings included a T2 hyperintense contrast-enhancing lesion in the pons, as well as non-contrast enhancing T2 hyperintense lesions in periventricular and juxtacortical regions as well as in the thoracic spinal cord. What is the next step to confirm her diagnosis?

Identify the lesion shown below.

Damage to which of the following muscles can lead to scapular winging?

A 34-year-old woman comes to the emergency room with complaints of neck stiffness, headaches that are worse on standing, and diplopia. An MRI brain with contrast shows diffuse dural enhancement. Which of the following findings is also likely to be present in this case?

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

Which of the following statements is correct regarding F-waves?

A 60-year-old woman with a history of diabetes is presenting to the neurology clinic with a 4-month history of burning/tingling in her bilateral toes. Neurological examination revealed 5/5 strength in all muscle groups, normal reflexes, and intact sensation to light touch in the bilateral lower extremities. There was mildly decreased sensation to pinprick in the 1^st toe bilaterally. Which of the following tests is the most likely to be diagnostic for this patient?

Which of the following testing can be used to diagnose a small fiber neuropathy?

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 findings would most likely be found on histopathological analysis of the lesion shown in the image below?

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

Identify the darkly stained structures.

A 32-year-old female presents to the emergency room after a motor vehicle accident as a restrained back seat passenger. Her only complaint on arrival is back pain. She has bruises across her abdomen and chest and a normal neurological exam. Thoracic spine imaging was completed and is shown below. Which of the following is the most likely diagnosis?

Which of the following medications used in the management of multiple sclerosis is the most teratogenic?

A 31-year-old male comes to the clinic for evaluation of recurrent nightmares after returning from a tour of duty with the military two months ago. He is unable to concentrate on his new desk job and flinches every time he hears a door close. While once an avid bowler, he no longer goes to the bowling alley because the sounds of the pins falling remind him of bomb explosions. Which of the following is the most likely diagnosis?

Which of the following findings on a Head-Impulse-Nystagmus-Test-of-Skew (HINTS) test is consistent with central vertigo?

You are caring for a 1-year-old girl with severe refractory epilepsy with frequent focal seizures. She had normal developmental until 3 months of age when she had seizure onset as well as a loss of milestones. Continuous EEG revealed multiple seizure types, with multiple foci of onset in each hemisphere. The seizures appear to migrate between hemispheres on EEG, and clinically. Which gene is most often associated with this disorder?

Of the following, which extraocular muscle is not innervated by the oculomotor nerve?

You are caring for a 65-year-old that sustained a small hypertensive intracranial hemorrhage. Early physical therapy is initiated. They discover that while she can sit unassisted, she is unable to stand. When standing, she sways and falls forward, backward, or to one side. On a detailed physical exam, strength is 5/5 to flexion and extension at the ankle, knee, hip, shoulder, elbow, and wrist bilaterally.

Which of the following locations of the bleed best explains this finding?

A 75-year-old female with a past medical history of atrial fibrillation and hypertension presents to the ER with garbled speech. She seems unaware that her speech is nonsensical. On physical exam, she is unable to follow verbal commands but can understand visual cues. An ischemic injury is suspected. If this is true, a brain MRI would show which of the following areas of the brain is/are affected?

A 3-day-old male infant is evaluated in the NICU for fever and focal seizures. He was born at 39 weeks gestation via uncomplicated vaginal delivery and had good APGAR scores. Brain imaging shows periventricular calcifications and severe ventriculomegaly. Auditory testing also demonstrates bilateral hearing impairment. What is the most likely cause of the patient’s symptoms?

A 65-year-old man presents to the emergency room with progressive weakness over the course of several months. Examination shows pure motor weakness with no sensory involvement, decreased reflexes, and diffuse fasciculations. An EMG shows conduction block of motor neurons outside of compression sites and normal sensory conduction velocities. Which of the following antibodies is associated with this disease?

A 12-year-old patient with neurofibromatosis type I is found to have a cerebellar cystic mass with a mural nodule and contrast-enhancing rim after presenting with symptoms of increased intracranial pressure. The lesion was surgically resected and an example of the pathologic findings is shown below. What is the most likely diagnosis?