Quiz 07/31/2022

A 7-day-old infant is in the hospital since birth when he starts having seizures. He has been feeding poorly thus far. On examination, he has hypotonia, as well as distinctive facial features of midface hypoplasia, hypoplastic supraorbital ridges, and a prominent high forehead. The metabolic testing panel returns with elevated very-long-chain fatty acids. What is the physiology of this disorder?

Identify the lesion shown in the imaging below:

A 6-year-old developmentally normal male presents after experiencing an episode of jerking of the right side of his mouth and inability to speak lasting 2 minutes. The patient is now back to baseline and has an EEG performed. Based on this clinical picture, which of the following abnormalities would you most expect to see on the EEG?

A nine-month-old boy with no significant past medical history is brought to the clinic by his mother because of paroxysmal episodes of unknown etiology. His mother states that since he was six months old, she noticed that his head would intermittently tilt to his right lateral side when he woke up. His head tilt would always disappear during sleep. During these “attacks” the patient would become irritable and would occasionally vomit. The symptoms last up to 48 hours before resolution. Imaging of the brain and EEG do not demonstrate any abnormalities. Which of the following is the most likely cause of these symptoms?

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

Identify the structure (blue arrow) shown below:

The lesion shown below is most consistent with which of the following pathologies?

A patient presents to the emergency room after experiencing a syncopal event. On history, he endorses unilateral, paroxysmal pain in the tonsil, tongue, and ear triggered by swallowing. What is the most likely diagnosis?

A 78-year-old male with a past medical history of depression and chronic alcohol use presents to the clinic with his wife for evaluation of a tremor. He states that the tremor is most severe at rest and disappears with purposeful movement. His wife states that he has been having slower movements over the past year. On physical exam, a “pill-rolling” resting tremor is noted in his left hand and the patient has difficulty with gait initiation and takes short steps when walking forward. Which dopaminergic pathway is most likely affected in this patient?

Vasogenic edema would be best appreciated on which of the following MRI sequences?

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?

Which of the following correctly identifies the cranial nerve(s) that transverse through the structure (blue arrow) shown below?

A two-month-old female presents to the clinic with her mother for episodes of abnormal posturing of her head, neck, and abdomen when breastfeeding. Her mother states that the episodes last approximately 30 seconds to 1 minute. Episodes are followed by crying. Her birth history was normal, and she has met all of her developmental milestones. Of the following, what is the best treatment for this patient’s condition?

A 37-year-old male presents with sudden onset of tachycardia and hypertension, followed shortly by unilateral rhythmic facial and then arm jerking. The autonomic symptoms of tachycardia and hypertension are most likely to reflect the involvement of which region of the brain during a seizure?

A 62-year-old woman presents to your clinic with complaints of dizziness. She states that about 2 weeks ago she had some dental work done including a root canal, and ever since then has had spells of extreme dizziness. She describes that the room spins and she becomes sick to her stomach. The sensation is improved by sitting very still. It completely resolves in between episodes, and episodes happen about once or twice a day. She noticed that it happens consistently when she tries to back out of the driveway in the early morning. She had a CT head one day ago that was read as normal. On exam, she has inducible nystagmus. The otoscopic exam is normal. Which of the following is the most accurate statement?

A 65-year-old man with a history of severe depression is bought to the clinic by his wife after losing 15 pounds in the last month. The patient states that he believes that his stomach and intestines have been removed and that he died several weeks ago. Which of the following is the most likely diagnosis?

An MRI is ordered on a man with a known history of ischemic stroke and bilateral upper extremity weakness. Which of the following was the most likely cause of his ischemic injury?

Which of the following dermatomes are correctly matched with their associated anatomical location?

A 19-year-old woman was brought to the emergency department after a rollover motor vehicle accident. On arrival, she was intubated and sedated for respiratory failure secondary to pneumothorax. Examination revealed intact brain stem reflexes and decreased spontaneous movement of the left side of her body. Her axial head CT scan is shown below. What is the most likely diagnosis?

A 37-year-old female with a PMH of Sjogren’s, and a recent motor vehicle accident (MVA) is referred to the EMG Lab for evaluation of right arm pain/weakness. The patient endorses right head pain which radiates down her neck into the right shoulder and wrist. Examination shows 5/5 strength in the upper extremities except for 4+/5 deltoid and 4+/5 biceps strength in the right upper extremity. Sensation to light touch was intact throughout. Sensory nerve conduction studies of the right upper extremity were normal. Based on the patient’s EMG results outlined below what is the most likely diagnosis?

A patient with Alzheimer’s disease donates their brain for research on neurodegenerative disease. A histopathologic, H&E-stained, sample of his brain tissue is shown below. What is the structure marked by the black arrow?

A 48-year-old woman presents with acute onset of seizures, myoclonus, ataxia, and rapidly progressive dementia. CSF analysis reveals an elevated protein and mild pleocytosis. Brain MRI with and without contrast is unremarkable. Further investigation reveals elevated thyroid-stimulating hormone levels and anti-thyroid peroxidase antibodies. Which of the following is the most appropriate therapy?

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?

Which direction are the patient’s eyes moving at the points marked by the green circles?

Which of the following vessels drains into the sigmoid sinus?

Which of the following is the most likely cause of the findings appreciated on the axial CT head shown below?

A 37-year-old woman with a history of chronic alcoholism and amphetamine abuse presents to the ED with a 36-hour history of recurrent hematemesis and abdominal pain. She had no detectible ethanol levels in her blood on arrival. In the ED she complains of double vision and is started on intravenous fluid replacement. Two hours later the patient begins to develop ataxia and becomes progressively disoriented. The patient’s rapid deterioration is most likely due to which condition?

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

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

Which synapsed of the peripheral nervous system is acetylcholine the primary neurotransmitter?