Neurology Quiz
Test your neurology acumen!
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A 52 year old woman with a history of gastric bypass presents with confusion. She has had poor oral intake for several days due to recent gastroenteritis.

On exam you note that she tells a somewhat fragmented story of the past few days, the details of which are verified as untrue by a family member. She also is noted to have partially restricted abduction of eye movements bilaterally. 

MRI brain is done which shows increased T2 signal in the periventricular gray matter. 

Deficiency of which of the following is most likely the cause of her symptoms?
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1 point
A 34 year old right handed man presents with a 7 year history of non-dominant temporal lobe epilepsy. 

He is currently on high doses of levetiracetam and lamotrigine. Past antiseizure medications include topiramate which was stopped due to side effects and lack of efficacy. 

He continues to have approximately one focal seizure with impaired awareness per month. These will progress to a bilateral tonic clonic seizure 
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1 point
A 72 year old right handed man presents with acute onset of left sided weakness. On examination you note the patient has a left homonymous hemianopia, rightward gaze preference, a left facial droop, weakness of the left arm, and left sided neglect. The left leg is relatively spared. 

What vessel is most likely affected?
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1 point
A 40 year old man presents for evaluation of the inability to sit still. He has been told that he constantly appears to be "fidgeting." This has been getting gradually worse over the last 1-2 years. He recalls his father had similar movements, but they didn't show up in him until he was in his 60's. 

What testing is most likely to reveal the diagnosis?
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1 point
A 60 year old man presents to the clinic due to complaints from his spouse. His spouse states that the patient frequently thrashes around violently in his sleep, and has even struck her while he has been asleep. 

You refer the patient for a polysomnogram which diagnoses REM sleep behavior disorder (RBD). 

Which of the following conditions is most associated with RBD?
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1 point
A 70 year old woman has recently been diagnosed with breast cancer. While preparing to start treatment she begins to develop worsening coordination over 2-3 weeks. 

MRI brain with and without contrast is unremarkable. 

Which of the following antibodies is most associated with the clinical presentation?
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1 point
A 48 year old man presents with complaints of right hand pain. He describes numbness in tingling in the hand on waking which he has to "shake out" and has noted he occasionally has been dropping things at work. He does not have any neck pain nor does he note the sensation changes above the wrist. 

On exam you note decreased pinprick sensation over the thumb and index finger. Strength if 4/5 with thumb abduction but 5/5 with finger adduction and abduction. Reflexes are normal. 

What is the most likely diagnosis?
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1 point
A 32 year old woman presents with bilateral lower extremity weakness and numbness. This had been getting gradually worse over the last 1-2 weeks, and has now progressed to the point she cannot walk.

On exam you note 1/5 strength diffusely in the bilateral lower extremities, but 5/5 in the bilateral upper extremities. Sensation is diminished to pinprick and vibration up to the T8 level of the trunk. Reflexes are 2+ in the arms and 3+ in the legs. You also note moderately diminished visual acuity in both eyes.

MRI of the brain shows mild enhancement of the bilateral optic nerves but no lesions of the brain parenchyma. The thoracic spine MRI shows a longitudinally extensive T2 hyperintense lesion which also enhances on post-contrast sequences.

Which of the following tests is most likely to reveal the diagnosis?
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1 point
A patient presents with acute onset of aphasia and weakness of the right face and arm. Vascular imaging demonstrates 80-90% stenosis of the bilateral internal carotid arteries.  

Which of the following steps would be most appropriate to reduce stroke risk going forward? 
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1 point
A 24 year old woman presents with holocephalic headaches going on for several months. She has noted increasing blurred vision for two weeks now. MRI brain with and without contrast is unremarkable. Which test would likely lead to the correct diagnosis?
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1 point
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