Quiz 07/31/2022

A 31-year-old female with depression, anxiety, and migraines presents to the ED for altered mentation. On arrival, she has a temperature of 41 degrees Celcius, HR 130, and a systolic blood pressure of 190. On exam, she is diaphoretic and agitated, with increased tone, hyperreflexia, shivering, and dilated pupils.

You call her family who states that the patient has a hard time keeping down a job, frequently moving from state to state. She has had a number of different psychiatrists over the years, and you, therefore, are unable to find a comprehensive medication list. In her purse, she has a pill bottle of sertraline, with 85/90 pills remaining.

Which of the following other medications is this patient likely taking?

A 37-year-old man with poorly controlled diabetes mellitus presents to the emergency department with a three-day history of progressive headache, fever, and double vision. Examination shows bilateral proptosis, peri-ocular erythema, and ophthalmoplegia. CT of the head was ordered and showed bony destruction of the sinuses. Based on the most likely diagnosis, which of the following is the most appropriate treatment?

A 1-year-old female with a past medical history of iron deficiency anemia presents to your clinic with her mother for recurrent episodes of loss of consciousness. Her mother states that whenever she gets very agitated and starts crying, her lips turn blue and she will ”pass out.” She will then awaken after a few seconds. Her neurological exam is normal. Which of the following is the most likely cause of her episodes?

A 27-year-old woman presents with recurrent episodes of tinnitus, vertigo, and hearing loss. She denies any associated headaches. Episodes typically last between 2 and 6 hours in duration. MRI of the brain with and without contrast did not reveal any pathology. Physical examination is unremarkable except for sensorineural hearing loss appreciated in the right ear. Which of the following is the most likely diagnosis?

The paraspinal muscles are innervated by which of the following?

A 30-year-old male presents to the clinic with a fifteen-year history of progressive weakness and sensory loss in his lower extremities. Examination shows hammertoes, high arches on his feet, 4/5 ankle dorsiflexion strength, and a mild decrease in sensation to pinprick in the 1st toes bilaterally. Upon questioning he mentions that his father had similar-looking feet and started to use a cane in his fifties. What is the most likely diagnosis for his symptoms?

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

A 6-month-old male is admitted to the ED for acute respiratory failure. On examination, he has generalized weakness, diffuse hypotonia, and areflexia. He was admitted to the pediatric Intensive Care Unit and intubated. A chest X-ray showed a narrow chest. EMG/NCS was performed showing axonal motor polyneuropathy with tongue fasciculations and signs of chronic denervation. What is the most likely pathologic etiology causing this presentation?

A 65-year-old right-handed man presents with acute onset speech difficulties, a mild right-sided facial droop, and right-sided arm weakness. While talking to his wife over breakfast this morning he suddenly stopped speaking and could only make unintelligible sounds. On examination, he is unable to speak any words but has intact comprehension. He is able to write clearly what he wants in full sentences with intact grammar and reading is also preserved. Which of the following best describes his language deficit?

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?

A 65-year-old right-handed man presents with an acute onset of aphasia. CT scan of the head was normal but the MRI revealed multifocal small acute and subacute ischemic strokes in multiple vascular territories. A cerebral angiogram was performed as part of the diagnostic workup. Based on the clinical history and imaging provided what is the most likely diagnosis?

A 24-year-old female in her third trimester of pregnancy, with no other past medical history, presents with complaints of 1-2 times monthly episodes of sudden onset severe room spinning, nausea, and vomiting for 3 months. They happen randomly and are not associated with head movement. During an episode, sounds and bright light seem to bother her more. She denies motor weakness or hearing change. Her spells resolve after about 1 hour. She endorses she has had bad headaches in the past, but not with these episodes. She endorses she gets car sick easily. On neurologic examination, she has no focal findings, and her vitals are within normal limits. She had an MRI brain with MRA and MR Venogram, all of which were unremarkable. Which is the most likely etiology?

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

Immunohistochemical staining with GFAP is particularly useful in identifying which of the following cell types?

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