Quiz 07/31/2022

Which of the following medications has a relatively low risk of sexual dysfunction?

Neural tube defects will develop at which point in fetal development?

An MRA is ordered for a patient presenting with an acute stroke. Based on the lesion appreciated in the image below (white arrow), what symptom is likely to be seen on examination?

A neurology consult is placed on a full-term newborn male after being delivered by an uncomplicated vaginal delivery with good APGAR scores. The physical exam reveals a midline lesion in his lumbar region. Based on the pathology shown below, which of the following would most likely also be present on head imaging?

A 6-year-old male is brought to the pediatrician with multiple-decaying teeth since 2-3 years of age with no associated pain. He was born via C-section at term with no complications. Past medical history is significant for developmental delay and intellectual impairment. On physical exam, the patient is short-statured and obese with hypogonadism. His parents state that he has always been an overeater. What is the most likely diagnosis?

What type of tumor is showcased in the pathologic image below?

Which of the following is the most classic finding of early inclusion body myositis?

A 65-year-old male comes into the office with his wife for follow-up after a recent hospitalization for HSV encephalitis.  The wife says before his hospitalization, he used to be a quiet, shy man but recently has been making sexually inappropriate remarks to women at the park. The patient also has an increase in appetite and an urge to touch everything at the grocery store. Based on his cognitive deficits, which of the following areas of the brain is likely affected?

A 35-year-old male with balance issues is referred for an EMG/NCS. Distal sensory loss of the feet, high-arched feet, and diffuse hyporeflexia are appreciated on the exam. His nerve conduction studies are shown below. Based on the available information what is the most likely diagnosis?

A 65-year-old male with a past medical history of diabetes, hypertension, and a 40-pack-year smoking history comes into the ED with an acute onset of ataxia, left facial numbness, right arm, and leg numbness, and dizziness. He also has intractable hiccups. A CTA angiogram shows the cause of the patient’s symptoms. Based on the clinical exam, which of the following arteries is occluded?

A 72-year-old man with a history of right-sided carotid stenosis was transferred from an outside hospital to your institution to have a carotid stent placed after experiencing a mild right-hemispheric ischemic stroke. The patient was sent to the angiography lab and had a carotid stent placed, however, it was done so on the unaffected (left) side. What is this an example of?

A patient presents to the emergency room with sudden onset weakness and dysphagia. On exam, the patient’s tongue deviates to the left, and there is right hemiparesis and right-sided loss of position and vibratory sensation. Pain and temperature sensation is intact. Which of the following arteries supplies blood to the damaged area?

Which of the following is the most likely cause of the findings seen on this gross pathology image?

This brain biopsy is representative of which of the following tumors?

What is the pathophysiology of the lesion provided below?

An 85-year-old man presents back to your clinic for follow-up with his family for a slowly progressive neurologic decline over the past 4 years, namely with memory and cognitive decline. You have already performed a brain MRI and additional testing and suspect that the patient has Alzheimer’s dementia. The family expresses concerns over the patient’s driving. Which of the following, if true, is not a useful tool to identify driving risk according to updated practice guidelines?

Which of the following genes is responsible for familial ALS?

A 2 month-old female is brought to the emergency room by her mother after she noticed abnormal movements concerning for possible seizure. The child was born at term and was the product of a normal pregnancy and delivery. While gathering a history, the child is lying on the bed still when you notice repetitive movements of his bilateral lower limbs. When her mother notices she picks up the patient and the movements resolve. What is the most likely diagnosis?

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 48-year-old male with a history of a gunshot wound to the shoulder presents with left arm pain and weakness. The video below is a recording of his EMG of the brachioradialis muscle with activation. Based on the EMG findings, how long ago did the patient’s gunshot injury most likely occur?

Which of the following syndromes are most likely associated with the lesion shown in the image below?

An 11-year-old female presents with worsening stiffness. She had no complications while in utero or at birth, yet ever since she started kindergarten she noted to have stiffness in her feet and ankles, which worsens by the end of the day. She eventually started to notice modest stiffness in the legs and mild stiffness in the neck. She underwent physical therapy for this and remained stable. Over the last 2 years, however, the symptoms have been worsening. Which of the following next steps is most indicated?

This gross microscopic image is most consistent with which of the following diseases?

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 lesion to which of the following hypothalamic nuclei causes hyperphagia?

A patient with right leg weakness presents to the neuromuscular lab for electromyography. The image below depicts a spontaneous finding while evaluating the right tibialis anterior muscle. This finding is most consistent with which of the following?

A 41-year-old female smoker with HTN is admitted to the Neuro ICU after having acute onset worst headache of life, found to have hyperdensity tracking sulcal lines on CTH. Her physical exam is otherwise normal on admission. On the fourth day of admission, she develops acute onset right arm and leg weakness and aphasia. She was last seen well 30 minutes prior. Which of the following is true?

Which of the following is the correct order of internal carotid artery segments (from proximal to distal)?

A 34-year-old schoolteacher presents to the emergency department with confusion and weakness. Her family reports they have been staying at their cabin for labor day weekend and the patient spent the whole time inside complaining of generalized fatigue, myalgia, headache, and light sensitivity. They felt she had “a cold” so they let her rest. This morning, Monday, she was found in her bed unable to move and confused.

On exam, she is disoriented. She has nuchal rigidity. On musculoskeletal exam, she has diffuse but left > right weakness in the limbs. Her reflexes are 0/4 in the bilateral ankle, knee, and brachioradialis, and 1+ in the bilateral biceps. The sensory exam is normal.

The serum glucose is 100. Lumbar puncture is performed and shows glucose 60, protein 55, RBC 1, and WBC 25, lymphocyte-predominant.

Which of the following is the most appropriate preventive measure for this condition?

A 65-year-old female presents with an abrupt onset of akinetic mutism, lack of motivation, apathy, bilateral leg weakness, and incontinence. A lesion to which of the following vascular territories could explain her symptoms?

An 18-year-old woman with a history of symptomatic epilepsy presents with medically-refractory seizures. An MRI brain is performed during presurgical evaluation and reveals the non-contrast-enhancing lesion shown below on T2 FLAIR. This lesion is most likely which of the following?

Which of the following medications used in the management of attention deficit hyperactivity disorder (ADHD) can worsen comorbid Tourette syndrome if present?

A young infant is found after birth to have an abnormality of the left arm. The arm is held down by the infant’s side, adducted and medially rotated, and the forearm is extended and pronated. What is the anatomic location of the injury causing the deficits?

Which of the following medications is associated with sudden irresistible attacks of sleep?

A 36-year-old man with no significant past medical history presents with lower back pain, lower extremity weakness, and urinary incontinence. A non-contrast enhancing lesion was found on lumbar MRI (T1 sequence without contrast image shown below). What is the most likely diagnosis?

Which of the following findings is depicted in the MR Angiogram shown below?

A 74-year-old female presents to the ED for trouble with swallowing and balance. On physical examination, she is unable to speak clearly and has no gag reflex. Pain and temperature sensation on the right side of her body and the left side of her face is decreased. She is unable to walk unassisted and has dysmetria on the finger-to-nose exam. MRI of the brain shows an ischemic stroke. The artery that is affected most commonly branches off of which of the following?

Which of the following genes is associated with Wilson’s disease?

A 71-year-old male with a history of mild ankle weakness and balance issues for the last 6 years is referred to the lab for a nerve conduction study (NCS). While performing the testing the patient states that a few of his siblings, as well as his father, had similar issues. Examination showed high arches and hammertoes. Based on the clinical history and NCS, what is the most likely diagnosis?

Which of the following forms of Charcot-Marie-Tooth (CMT) disease causes axonal polyneuropathy?

A 65-year-old male with a history of alcoholic cirrhosis presents to the emergency department with dark black coffee-ground emesis. He is found to have a systolic blood pressure of 76/40 and is tachycardic to 120 BPM. Which nerve is most responsible for carrying the afferent fibers from carotid sinus baroreceptors that cause the reflex increase in heart rate seen in this patient?

Metachromatic leukodystrophy is due to a deficiency of which of the following enzymes?

Which of the following is the correct order of venous structures related to cerebral blood drainage?

Which of the following drug-mechanism pairs is incorrect?

A 67-year-old male with a past medical history of hypertension and diabetes presents with a 5-day history of facial paralysis and an ear rash. The patient states he returned from a 4-day backpacking trip in the Adirondacks 2 weeks ago in upstate New York where he engaged in hiking and freshwater swimming. His temperature is 36.9 °C (98.5°F), pulse is 72/min, and blood pressure is 131/78. Examination reveals an erythematous vesicular rash in the left auditory canal and pinna and drooping of the left face, forehead, and eyelid. A Weber test lateralizes to the right ear and a Rinne test shows air conduction greater than bone conduction in both ears. What is the most likely diagnosis?

A patient who was admitted to the neurology intensive care unit for myasthenic crisis developed ventilatory-associated pneumonia on the fifth day of his hospitalization. On the day following the initiation of antibiotic therapy, there was a significant decline in the patient’s respiratory status. Which of the following antibiotics most likely contributed to the patient’s respiratory distress?

You are asked to see a 2-month-old infant girl with hypotonia, macroglossia, failure to thrive, and cardiomyopathy. Muscle biopsy is done due to the hypotonia, and shows PAS+ vacuolar myopathy. What is the best treatment approach?

A 38-year-old woman with a history of gastric bypass begins taking over-the-counter supplements that are intended to promote hair and nail health. After several months, she begins to experience paresthesias in her legs and has several falls. She is referred to a neurologist. On examination, she is noted to have non-length-dependent severe loss of vibration sensation in her legs, loss of pain and temperature distally in a length-dependent pattern, and spastic tone with hyperreflexia in her lower extremities. Additionally, her gait is wide-based and a Romberg’s sign is positive. Which of the following treatments is most likely to prevent further neurologic deterioration?

A healthy 12-year-old female has a brain MRI performed because of a history of medically refractory headaches. Her imaging is shown below. What is the diagnosis?

Stevens-Johnson syndrome associated with carbamazepine use is more likely in patients with which of the following HLA alleles?