Quiz 08/01/2022

A 29-year-old female taking oral contraceptive pills (OCPs), but with no other known medical history, presents for a 3-week course of progressive headache. Given her risk factors, the following imaging study is performed. An occlusion within which of the following structures is seen?

Which of the following seizure characteristics are typically seen in patients with temporal lobe epilepsy?

A 67-year-old male presents to the clinic with his wife due to a gradual decline in his balance over the past two years. His balance issues have resulted in him falling twice in the past month. His wife states that she notices that he has been walking more slowly than usual. The patient also complains of double vision when reading the newspaper. On physical exam, the patient is noted to have a vertical gaze palsy and impaired smooth ocular pursuit, and a subtle right hand resting tremor. A brain MRI is ordered which shows atrophy in the midbrain tegmentum. What is the most likely diagnosis?

A 35-year-old man developed a right clavicle fracture after an accidental fall from a ladder while hanging Christmas lights. He was treated conservatively with a figure-of-eight bandage and sling. He presents to your clinic 2 weeks after the accident. He states ever since the accident he has had right arm and shoulder pain, as well as numbness extending from his triceps to his middle dorsal aspect of the forearm, wrist, and dorsal aspect of digits 1,2 and 3. On examination, his strength is 5/5 throughout all extremities except 4/5 to abduction of the deltoid, extension of the triceps, and wrist extension.

Which nerve or cord, if injured by the clavicle fracture, would explain his symptoms?

An 82-year-old woman donated her brain to science for post-mortem analysis (see below). Which of the following symptoms did the patient most likely experience before her passing?

Which of the following is not a recommended screening test for cognitive dysfunction?

A 30-year-old male presents with progressive dysphagia over the last month. Head imaging is completed and shown below. Which of the following is the most likely diagnosis?

A 39-year-old homeless man presents to the emergency room with fever, headache, and meningismus which has slowly progressed over the past 3 weeks. The patient is lethargic and agitated when aroused. Neurological examination reveals an isolated left abducens nerve palsy. Funduscopic examination reveals blurring of the optic discs. An MRI is performed and shown below. What is the most likely diagnosis?

A 47-year-old man with a history of bilateral cataract surgery at the age of 20 presents to the clinic for evaluation of progressive unsteadiness and cognitive decline. His father and older brother reportedly had similar symptoms in their early adulthood as well. On exam, there is notable dysmetria and gait ataxia. There were also abnormal soft-tissue masses appreciated near the Achilles tendons bilaterally. Which of the following is most likely to be abnormal in this patient blood?

Paralysis of the stapedius muscle can occur with ipsilateral damage to which cranial nerve?

A 68-year-old woman presents to the emergency room with a 3-month history of worsening cognition, ataxia, dysphagia, and periodic episodes of brachial dystonia, and facial grimacing. A continuous EEG was performed but no EEG correlate was seen with the abnormal movements. An autoimmune process is suspected. Which of the following serum autoantibodies is most likely present?

An 8-year-old girl is brought to the clinic by her mother for complaints of progressive insomnia, difficulty walking, and worsening vision. On exam, the patient is found to be unable to look upwards and her pupils accommodate but fail to react to light. On further questioning, it is found that menarche occurred at 7 years of age. MRI is most likely to demonstrate a tumor of which brain structure?

A 72-year-old female presents to the clinic with her husband who states that she is “seeing things that aren’t there”. For the past two weeks, she has been complaining of bats flying around her room at night. Comparable visual disturbances have occurred over the past year, but have gotten progressively worse recently. She has also been acting out a lot at night; her husband states that she has been violently kicking and flailing her arms while asleep. Finally, she has been experiencing cognitive decline, including forgetting where she lives, what year it is, and the names of her grandchildren. On exam, there is symmetric cog-wheel rigidity appreciated. What is the most likely diagnosis?

An 80-year-old female presents with abnormal eye movements and cognition. She has also been experiencing problems with gait and memory. An MRI of the brain revealed midbrain atrophy, with relative sparing of the other brainstem structures. Which of the following is the most likely diagnosis?

A 78-year-old woman is brought to the neurology clinic by her husband for memory loss. Her husband states for the past 6 months he has noticed a progressive decline in her memory, particularly with recent events. She has also lost her keys and cell phone on numerous occasions around the house. Her MOCA score in the clinic was 25/30, with points lost for poor delayed recall and attention. Neurodegenerative disease is suspected. Which of the following medications is the most appropriate for this patient to help with her cognition?

An 83-year-old man presented with an acute onset of difficulty walking and nausea about 12 hours prior to being seen in the emergency room. Examination revealed vertigo and truncal ataxia. An MRI was performed to evaluate for stroke. The FLAIR axial MR image is shown below. What is the vascular territory damaged in the imaging provided?

Patients with Von-Hippel Lindau (VHL) syndrome are at risk of developing which of the following?

A 23-year-old female with a history of optic neuritis presents with a 1-week history of left leg weakness. Neurologic examination reveals decreased strength of the left lower extremity. A lumbar puncture reveals oligoclonal bands with lymphocytic pleocytosis. What stain can be used to identify the dysfunctional cells in this condition?

Identify the finding noted with a blue arrow.

The abnormalities appreciated on the MRI below are due to a defect in which of the following processes?

A patient with a history of hypertension and provoked seizures secondary to posterior reversible encephalopathy syndrome (PRES) has come to your clinic for a 6-month follow-up after her associated hospitalization. It was found that abrupt discontinuation of her hypertensive medications due to medication noncompliance was the cause of the PRES. She was started on the anti-seizure medication (ASM) levetiracetam at the time of her PRES and has had no seizures since being discharged. She asks you about the risk of future seizures. What is the most appropriate response?

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

Which of the following medications increase the risk of contraceptive failure in patients taking estrogen-containing oral contraceptive pills (OCPs)?

A 16-year-old male is seen in the clinic for burning and tingling sensations in his upper hands and feet. Additionally, he is a soccer player and states that he does not sweat during physical activity. On physical exam, he has diffuse red-blue papules in his gluteal region, around his navel and nipples, and on his buccal mucosa. There is no family history of skin lesions. This patient likely has a defect in which protein?

A 17-year-old woman with no significant past medical history except for an upper respiratory tract infection 2 weeks ago presents with a one-day history of fever, headache, and altered mental status. On examination, the patient also had right-sided ataxia. An MRI brain was ordered and T2 sequence images are shown below. The lesions showed minimal lesional enhancement with contrast administration (image not shown). What is the most likely diagnosis?

A two-week-old female is evaluated in the clinic. Upon physical exam, you notice a dimple and overlying tuft of hair on her lower back. This finding is most likely associated with a defect that occurs during which week of gestation?

What is the mechanism of action of dabigatran?

Which of the following findings is depicted in the vessel imaging shown?

Socially inappropriate behavior, disinhibition, echopraxia, and utilization behavior are typically seen in which of the following?

Patients with narcolepsy and cataplexy have a deficiency in which of the following neuropeptides?

A 50-year-old man presents with slowly progressive cognitive decline and personality changes. Over the past several months, he has been having trouble remembering the names of relatives/close friends and he has also become more apathetic. He is known to have trisomy 21. His exam is notable for memory deficits, but no rigidity or tremor. What is the name of the region of the brain that synthesizes the neurotransmitter that is decreased in this patient’s disease?

Of the following, which region of the adult brain is most susceptible to hypoperfusion injury and ischemia?

A 65-year-old woman with a past medical history of hypertension presents with recent onset of bilateral eye discomfort and diplopia. She states that she is unable to completely close her eyes. On exam, pain is elicited when testing extraocular movements. Visual acuity and visual fields are unremarkable. MRI of the brain reveals excessive peri-orbital subcutaneous tissue bilaterally. Which of the following is the most likely diagnosis?

A 33-year-old woman with a past medical history of depression is brought to the clinic by her husband because of atypical behavior. For the past three weeks, her thoughts have become progressively more disorganized. She is also having auditory hallucinations. Similar behavior has been seen intermittently over the past five years. Despite having a history of depression, her husband says the depression has been well controlled for the last three months. Which of the following is the most likely diagnosis?

The pathologic findings on the image shown below can be secondary to bilateral mononeuropathies involving which of the following nerves?

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 65-year-old female presents with a complaint of burning and tingling of her feet. Symptoms started in her toes two years ago and now extend up to her ankles. Neurological examination showed normal strength and intact sensation to light touch and vibration but an impaired sensation to pinprick in the first toes bilaterally. If performed, which of the following studies would likely be abnormal?

Which of the following structures has an intact blood-brain barrier?

A 75-year-old female with a past medical history of hypertension on lisinopril presents to the emergency department with weakness on the left side of the body and a drooping right eye. On exam, her right eye is inferiorly and laterally deviated. This pupil is also non-reactive. Her strength is 3/5 on the left side. Where is this patient’s lesion?

A 42-year-old male presents as a trauma for a large motor vehicle accident. He is comatose, intubated but not sedated, and admitted to the trauma ICU. His brain imaging shows diffuse axonal damage. On examination, his pupils are reactive equally and corneal reflexes are intact, but otherwise, he has no motor response to pain, upgoing plantar reflexes bilaterally. The family asks if the patient is “brain dead”. Which of the following is not part of the confirmatory criteria on the standard brain death exam?

Which of the following is the mechanism of action for selegiline?

Which of the following is not a risk factor for suicide?

With of the following CMT types present with an axonal pre-dominant peripheral neuropathy?

A 7-year-old boy was brought to the ED by his mother for a three-week history of involuntary movements. He was initially seen by his pediatrician two weeks ago. MRI of the head was performed and was unremarkable. Methylphenidate was trialed for a presumed tic disorder but it had no benefit. The Movements resolve with sleep. On examination, he has difficulty controlling facial and extremity movements as well as maintaining tetanic contraction of his hands. There was also a newly appreciated cardiac murmur. What is the most likely diagnosis?

A 75-year-old patient is brought in by her husband because of word-finding difficulty.  On cognitive testing, the most impressive finding was that the patient could not recall many colors of the rainbow. Based on this finding, what kind of memory is most impaired?

Which is the following potentials on EMG has an irregular firing pattern?

The brain MRI (susceptibility-weighted imaging) shown below is most likely associated with which of the following conditions?

A 10-year-old girl is brought to the clinic with a 1-month history of progressive clumsiness. Neurological examination shows significant bilateral ataxia. Imaging was performed and showed a midline lesion in the 4^th ventricle. A biopsy was performed and shown below. Based on the most likely diagnosis, what is the most appropriate treatment plan?

A 6-year-old Amish female presents to the emergency department with a 2-month history of gradual cognitive decline and jerking limb movements. A routine EEG was obtained (see below). Which of the following diseases is consistent with these EEG findings?

A consult is placed for paroxysmal episodes in a 6-day-old male infant born at 32 weeks gestation. According to his mother, the infant seems to be shivering a lot “like he is cold”. The mother states that she has been wrapping him in warm blankets and keeping the room at a warm temperature. On physical exam, the infant is alert and interactive, without persistent focal neurological deficits. However, when touching the left arm, the patient develops a fine tremor that resolves after flexing the affected limb. Vital signs are within normal limits. Which of the following is the most likely diagnosis?