Brainstem
22 yo M presents with a one week history of sharp pain along the lower cheek and chin while shaving or brushing teeth on the right side. The pain is electric shock like quality and lasts seconds. What branch of what nerve is implicated in this pathology?
right mandibular branch of trigeminal nerve
45 yo M presents with weakness of the hands bilaterally, left worse than right. On exam, strength is 3/5 in the hand musculature with 3+ biceps reflex on the left and 2/5 strength in hand muscles on the right with absent biceps reflex. Sensation is intact to vibration and pain bilaterally. What is the diagnosis?
ALS
6 yo F is brought to clinic and mom is concerned about school performance. Last week, the teacher approached mom and said the patient is struggling in class and seems to be daydreaming. EEG performed shows 3-Hz spike and wave discharges. What is the diagnosis?
Absence seizures
36 yo M presents with midshaft humeral fracture following MVC. What important structure should you test for injury?
radial nerve
65 yo F presents with 3 hour history of left leg weakness. On exam, strength in the left leg is 0/5 with increased tone and 3+ reflexes. All other extremities are normal. What is the occluded artery?
right anterior cerebral artery
36 yo F comes to ED with left sided facial droop. Patient woke up 4 hours ago and had drooling from the mouth. On exam, face is asymmetric with loss of left nasolabial fold and is unable to raise eyebrow on the left side. Where is the lesion?
Peripheral CNVII palsy
18 yo F presents for annual medical exam who has no abnormalities on exam except for a grade 1 burn on the fingertips. When asked the patient says she must've placed her hand on the stove before it cooled off but didn't notice. On further exam, pain and temperature sensation are diminished in the upper extremities bilaterally, as well as neck, but intact elsewhere. What is the diagnosis?
syringomyelia
13 yo M was climbing a tree when the branch snapped and hung from one arm to another branch to prevent his fall. Presents to ED next day with extension of MCP joints, flexion of PIP and DIP joints. What is the diagnosis?
Klumpke palsy
36 yo M who works as a receptionist presents with right hand weakness and paresthesias. Sensation is decreased to the lateral 3.5 digits, but sensation is intact over the thenar eminence. What is the likely diagnosis?
carpal tunnel syndrome
54 yo M is walking into the exam room for his clinic visit and you notice that he swings his right leg out and his right pelvis drops with he ambulates. What nerve is injured and on what side?
left superior gluteal nerve
75 yo M who is admitted to the stroke service and you are the medical student asked to localize the lesion. The patient is quadriplegic and cannot speak, he is only able to track objects vertically, but not horizontally, and can still blink. What artery is occluded?
basilar artery ("locked in" syndrome)
75 yo M with underwent TAA repair yesterday presents with weakness of lower extremities, urinary retention, vibration sense is intact but patient does not withdraw to noxious stimuli. What is the lesion?
anterior cord syndrome (occlusion of anterior spinal artery)
15 yo F recently got over URI that now presents with 5 days of worsening tingling that began in the feet and now involves the hands as well. On exam, motor strength is 4/5 bilaterally in lower extremities and she is hyporeflexic as well. What would you expect to find on LP to confirm the diagnosis?
albuminocytologic dissociation
27 yo M who is a construction worker and had his left arm trapped under a cement block for 4 hours and now presents to the ED. A few hours after initial stabilization, the patient complains on increasing pain despite being on a morphine drip and getting PRN hydromorphone. On exam, patient has extreme pain to touch and tingling in his left fingers. What is the most urgent intervention to improve this patient's prognosis?
fasciotomy
32 yo F 6 hours postpartum attempts to get up and move around for the first time and her husband notices that her right foot slaps against the ground with each step. She also complains that she cannot feel the toe thong of her flip flops on the same side. What nerve is affected (be specific)?
deep fibular (peroneal) nerve
30 yo F presents with 6 month history of progressive bilateral hearing loss. Weber test is equivocal (does not localize) and air>bone in both ears from the Rinne test. On full review of systems, patient also complains that she sees halos around lights and fundoscopic exam is limited by hazy corneas. What genetic testing would you order after confirming the suspected diagnosis?
NF2 (merlin gene testing)
36 yo F with a history of alcohol use disorder presents with gait ataxia and diffuse weakness. On exam, patient has global muscular weakness and hyperreflexia, positive Romberg sign, and lower extremity paresthesias. Patient complains of pain around laceration on the left shin. What lab would you order to confirm the suspected diagnosis?
B12 (Subacute Combined Degeneration)
9 yo F recently immigrated from Pakistan with unknown PMH presenting to ED with left leg paralysis for the past day. On exam, patient has flaccid paralysis of left leg with loss of patellar and Achilles reflexes. What is the likely diagnosis and the most feared complication?
Poliovirus; respiratory failure
55 yo M presents due to shoulder pain after falling on shoulder. On exam, is able to abduct without assistance when leaning to the affecting side. When you ask them to abduct the affected arm to 90 degrees with 30 degrees of forward flexion and fully internally rotated, they are unable to resist against downward pressure. What is the most likely injured muscle?
supraspinatus
23 yo M presents to the ED after a skiing accident complaining of excruciating right knee pain. He is found to have torn his ACL, MCL, and medial meniscus. What exam maneuvers would have allowed the providers to make this diagnosis?
ACL - anterior drawer test (Lachman's)
MCL - valgus stress test
Medial meniscus (McMurray's with external rotation)
68 yo M presents with acute onset voice hoarseness, dysphagia, loss of pain and temperature sensation in right face, loss of pain and temperature in left side of body. Patient also has miosis of the left eye as well as anhidrosis. Where is the stroke?
lateral medullary (Wallenberg) syndrome
34 yo M was stabbed in the right lower back. MRI demonstrates right hemisection of the spinal cord at T8. What would your neuro exam reveal for fine touch, motor, and pain?
Fine touch - loss at T8 and below on right
Pain - loss at T10 and below contralateral; T8-T10 ipsilateral
Motor - LMN at T8 and UMN below ipsilateral
45 yo F presents with double vision at night. She also complains that after a few minutes of putting groceries away in the top cabinets she needs to take a break because her arms feel weak, but this improves after she takes a break. What imaging finding is commonly found on a CT chest in patients with this condition?
thymoma
6 yo M presents to ED due to not moving right arm after father swung the child while they were playing. Right arm is extended with forearm pronated. What is the next best step in management?
hyperpronation of the forearm OR supination with flexion of the elbow
24 yo F presents to the ED after forceful inversion of the ankle while stepping in a pothole while walking to EBL for neuroanatomy lecture. She is unable to walk and had pain with plantar flex and inversion of the affected foot. What is the most likely affected ligament?
anterior talofibular ligament (ATFL)