Group N - Week 52

A 28-year-old female presents to the clinic for evaluation of right foot drop with shooting pain from her back radiating to the lateral side of the right leg. Examination reveals dorsiflexion weakness as well as ankle eversion and inversion weakness. She also has decreased sensation on the dorsum of the right foot. Negative Babinski signs. Achilles reflex intact. What’s the most likely diagnosis in the patient?

• Compression of nerve root exiting at L4/L5 level

• Compression of nerve root exiting at L5/S1 level

• Compression of nerve root exiting S1/S2 level

• Fibular nerve lesion

• Tibial nerve lesion

A patient presents to neurology clinic with tingling in her hands and feet with painful limbs. Upon further workup, it is found that the patient experienced a “stomach bug” a couple weeks prior and now produces autoantibodies against a cell that helps produce a substance that insulates nerves and helps conduct nerve impulses. What cell is most likely affected?

• Oligodendrocyte

• Schwann cell

• Astrocyte

• Ependymal cell

• Dorsal root ganglia

A patient with a history of Parkinson’s Disease presents to the clinic for follow-up after receiving Levodopa/Carbidopa. Why is it necessary to add Carbidopa to the treatment plan?

• Carbidopa has synergistic effects with Levodopa to more efficiently regenerate myelin sheaths within the PNS

• Tight junctions formed between the foot processes of astrocytes and ependymal cells prevent peripherally produced dopamine from entering the CNS

• Tight junctions formed by oligodendrocytes prevent peripherally produced dopamine from entering the CNS

• Parkinson’s Disease involves an autoimmune reaction against myelin in the CNS, and the Levodopa/Carbidopa helps oligodendrocytes regenerate the myelin

Label each letter in the image using the following format:

A: ___; B: ___; C:___; D: ___; E: ___

(options: axon, myelin, endoneurium, perineurium, epineurium):

97 y/o retired hematologist Jeronimo Fang is concerned about one of his fellow nursing home residents. Her movements have gradually become slower and more effortful and she frequently trips over items on the floor because she has trouble looking downward. Unfortunately, treatment with Sinemet has provided no relief in these symptoms. If Dr. Fang paid attention in neurology, he should expect what additional finding?

• Positive applause sign

• Cogwheel rigidity

• Urinary retention and orthostatic hypotension

• Myoclonic jerks

Dr. Oreo Bonbon-Sign is conducting research on psychogenic movement disorders. Which of the following is not suspicious for psychogenic etiology?

• Rapid alternating movements start off slow and effortful

• A tremor that disappears when the patient is distracted

• A history of multiple psychiatric diagnoses

• Thrusting, exaggerated movements that are limited to one side

A 34-year-old man comes to his physician after experiencing strange jerky movements in his limbs and face which he cannot control. He also reports having mood swings and memory lapses. He says that his father displayed similar symptoms when he was in his 40s. Irregular, brief, purposeless movement of the hands is noted on examination.

Which of the following pathologic changes is most likely to be seen in this patient?

• Copper accumulation in the basal ganglia

• Neuritic plaques in the cerebral cortex

• Pigmentation loss in the substantia nigra

• Scattered periventricular plaques

• Ubiquitinated protein aggregates in the caudate nucleus

Gary is a 64-year-old man who presents to his primary care physician stating that he is having muscle weakness in his left foot. He is having difficulty lifting his foot off the ground when he tries to walk. He states that he started noticing weakness about 2 weeks ago and his legs have not improved since then. His vital signs are a temperature of 98.6°, blood pressure 138/81 mm Hg, pulse 69/min, oxygen saturation 99%, and respiratory rate 16/min. On physical exam, the physician notes that Gary’s patellar reflex on the left is 3+ and on the right 2+. Gary also has noticed that his left leg muscles twitch, and he is able to control it. He also reports that he has been having trouble swallowing solid food.

Hypothetically, anterior motor neurons would likely show which of the following on autopsy?

• α-Synuclein aggregates

• τ-Protein aggregates

• Bunina bodies

• Amyloid β aggregates

Match each type of amnesia with its correct causal factor using the following format:

1x, 2x, 3x, 4x, 5x (where x = corresponding letter)

Which hormone from which area acts on the amygdala to facilitate memory consolidation?

• Dopamine; substantia nigra

• Norepinephrine; locus coeruleus

• Acetylcholine; hippocampus

• Epinephrine; adrenal medulla