NSF Week 5

A 67-year-old male with history of hypertension presents to the ER with acute left sided weakness and dysarthria. He was last seen with a normal examination about 90 minutes ago. Which of the following would exclude him from being an IV tPA candidate?

What do the ASPECTS score and CT perfusion studies have in common?

A 42 year-old man who has a history of using cocaine presents to the ER because he reportedly became suddenly unresponsive after taking some drugs. On your assessment, you find that his blood pressure is 162/98 with a heart rate of 96. You note that his eyes do open with some minimal stimulation. He isn't following verbal commands. CT angiogram of the head shows a mid-basilar artery occlusion. Which of the following WRITTEN commands do you expect this patient to follow if he is in a locked-in state?

Please refer to the attached image to answer the following question: A 76-year-old right-handed female with history of diabetes presents with drooling on the right side of her face with completely paralyzed right arm and right leg. The patient is fully conversant (no aphasia) but has slurred speech (dysarthric). Which of the following most likely represents her MRI Scan?

A 59-year-old smoker with hypertension presents to the emergency room with signs of a stroke. Since you were a rock star in NSF, you told your attending that you think he has a brainstem stroke because he has opposite findings in his face and his body. You obtain an MRI brain and a CT angiogram quickly, and confirm that there has been a right PICA occlusion. What symptom is he most likely to have?

A 63-year-old woman presented to the hospital with new right arm weakness starting three days ago, but is otherwise well and on no medications. She has normal vital signs and mental status. An MRI of the brain shows evidence of 3 recent strokes (within the last 10 days). The first is a 1 cm lesion in the left frontal lobe, and accounts for current symptoms. A second stroke is a 2 cm infarct at the junction of the right medial posterior temporal and occipital lobes. A third stroke is a 0.5 cm infarct in the left parietal lobe. Which test would be the most likely to find the cause of her strokes?

Identify the correct risk that has been most strongly associated with natalizumab therapy for multiple sclerosis?

A previously healthy 17 year-old girl has a right reactive afferent pupillary defect that is noted in clinic visit, following a 2 day course of progressive eye pain and decreasing visual acuity in that eye. Which of the following treatments is most appropriate?

A 45 year-old (y/o) woman was diagnosed with bilateral optic neuritis at 19 y/o. She next had clinical symptoms with sensory loss in her left leg at 25 y/o. At that time she had multiple periventricular demyelinating plaques on a brain MRI, some of which were enhanced with contrast. She developed a transverse myelitis at 31 y/o. In the last three years, she has had increasing difficulty with lower extremity spasticity leading to loss of independent ambulation, and she has had steadily worsening cognitive difficulties and depression. All MRIs in the past 3 years demonstrate Gadolinium enhancement. Which clinical entity best describes the disease course?

A 37 year old woman has had 3 strokes over the last 18 months. Each infarct is in a different vascular distribution and small-medium in size. She has had negative telemetry, echocardiogram, carotid ultrasounds, and hypercoagulability workup. For CNS vasculitis, which of the following provides a definitive diagnosis?

A 23 year old graduate student seems strangely giddy to her friends over the past 5 days and she has begun saying bizarre things out of context to the situation. She is brought to the emergency room by her roommate after a seizure. Over the next few days, she has a worsening encephalopathy and new involuntary movements of the mouth and cheek. Which antibody test helped to confirm her diagnosis?

A 17-year-old woman has developed a worsening daily headache over the past year. She complains that her vision darkens for a few seconds when she coughs, and when she lies down there's a pulsatile ringing in her ears. She takes albuterol and fluticasone for asthma and she recently started taking tretinoin (Retin-A) for acne. What is the most concerning outcome if her headaches remain untreated?

A 25-year-old-first year medical student has started having intense headaches during the first 3 months of medical school. Her roommate is a second-year in NSF, and she becomes increasingly worried after seeing pictures of brain tumor pathology on her roommate's computer screen. Which of the following features of her headache would be most consistent with a primary headache disorder?

A 16-year-old boy has been having headaches with photophobia and phonophobia. They frequently last 3-4 hours, and the worst headaches cause him to vomit and miss school. He usually develops a blind spot in his periphery prior to his headache with shimmering lights around the edge. He used to treat his headaches successfully with ibuprofen, but this has become less effective. What would you recommend next for abortive treatment of these headaches?

A 62-year-old woman describes intense stabbing pain in her jaw ~5 times/day, and this is often precipitated when brushing her teeth on the right side of her mouth or drinking hot liquids. She has no autonomic symptoms. The most appropriate first-line treatment is which of the following?

A 26 year-old man with a history of anxiety presents with 2 weeks of severe headaches starting every day at 8 pm. His headaches are supraorbital, located solely on the left side and last up to 2 hours. What clinical features would you expect in this patient?

Please refer to the attached image to answer the following question: A 74-year old left-handed woman is brought to the clinic because of reduced awareness of stimuli on the left side of her body. When presented with food, she shows only interest in items on her right. You ask her to draw a clock (see image attached). Damage to what part of her brain is most likely to explain her symptoms?

While undergoing abdominal surgery, a 78-year-old man has a prolonged episode of hypotension. As a result of selective vulnerability, which of the following brain regions is most likely to have suffered injury?

Intracranial hemorrhage due to long-standing hypertension is most commonly located where?

Please refer to the attached image to answer the following question. a 68 y.o. woman is transferred from an outside hospital. The transfer note simply says "history of stroke". If her stroke is similar to the lesion in the photograph attached, the most likely time interval since the onset of her stroke is which of the following?

A 55 y.o. male w/ a hix of HTN, diabetes, coronary artery disease, alcohol use, and cigarette smoking presents with a sudden onset "worse headache" of his life, nausea, vomiting, and loss of consciousness. Non-contrast CT head is shown. What is the most likely etiology of hemorrhage?

A 68 y.o. male is brought to ED by his family for altered mental status. Medical hx is significant for coronary artery disease, transient ischemic attacks, COPD, and HTN. Over the past 2-3 weeks, he has been sleeping more than usual and he is confused. Physical examination is significant for orientation to self only and mild left upper and lower extremity weakness. CT scan demonstrates a crescent shaped hematoma. What is the most likely etiology?

In considering the blood brain barrier, which of the following is a characteristic of cerebral capillaries?

A 34-year-old woman presented with weakness of her right leg and tingling in her right arm. MRI demonstrated several welldemarcated lesions involving periventricular white matter and internal capsule extending into the thalamus. Which cell population is most likely undergoing cell death at this time?

Multiple sclerosis plaques can be active, inactive or shadow. Which of the following is a feature of an inactive multiple sclerosis plaque?

A 29-year-old woman presents with a neurologic disease that includes both spinal cord and visual symptoms, suggestive of neuromyelitis optica (NMO). Which of the following is a pathologic feature of NMO, but not multiple sclerosis?

A 75-year-old woman with atrial fibrillation presents to the emergency room and is found to have bilateral occipital strokes. Her pupils are reactive and she denies vision problems, but she bumps into things when walking and is unable to visually identify objects in the room. What is her diagnosis?

A 25-year-old man displays inappropriate social behavior and impulsiveness after recovering from coma due to severe head trauma. On neuropsychological testing, he performs poorly on tests requiring suppression of automatic responses, such as "go-nogo" and alternating sequences. Language function and visuospatial function are intact. He most likely has damage to which of the following?

Use the attached image to answer the following question. A 72-year-old man had sudden onset of confusion and was brought to the hospital. He was found to have a lesion similar to that shown in the attached photograph. Which of the following is the most likely diagnosis for this lesion?

Which of the following can account for low CSF concentration of a lipophilic molecule (2 correct answers)?