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Postreading
Self-Assessment and
CME Test
Eduardo E. Benarroch, MD, FAAN; Adam G. Kelly, MD
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1701
Postreading Test
A.
B.
C.
D.
E.
autoimmune encephalitis
Creutzfeldt-Jakob disease
CSF hypovolemia
hypoxic-ischemic encephalopathy
subarachnoid hemorrhage
basilar artery
contralateral middle cerebral artery
contralateral vertebral artery, V4 segment
ipsilateral anterior cerebral artery
ipsilateral internal carotid artery, extracranial segment
A.
B.
C.
D.
E.
1702
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October 2016
A.
B.
C.
D.
E.
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1703
Postreading Test
A.
B.
C.
D.
E.
b 8. Which of the following MRI sequences evaluates for the random movement
of water within tissues?
A.
B.
C.
D.
E.
1704
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October 2016
Reprinted with permission from Rowley HA. The alphabet of imaging in acute stroke: does it spell improved
selection and outcome? Stroke 2013;44(6 suppl 1):S53YS54. doi:10.1161/STROKEAHA.113.001939. B 2013
American Heart Association, Inc. stroke.ahajournals.org/content/44/6_suppl_1/S53.full.
A.
B.
C.
D.
E.
anemia
cardiomyopathy
cirrhosis
prior skull fracture
thrombocytopenia
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1705
Postreading Test
A.
B.
C.
D.
E.
1706
astrocytoma
cavernous malformation
dural arteriovenous fistula
Hodgkin lymphoma
myxopapillary ependymoma
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October 2016
cerebellar vermis
choroid plexus
dentate nuclei
hippocampi
mammillary bodies
A.
B.
C.
D.
E.
carotid-cavernous fistula
cavernous sinus thrombosis
lymphocytic hypophysitis
pituitary apoplexy
pituitary macroadenoma
b 14. Which of the following types of cancers, when metastatic to the brain, has
the highest likelihood of hemorrhage?
A.
B.
C.
D.
E.
colon cancer
lung cancer
nonmelanoma skin cancer
ovarian cancer
renal cell carcinoma
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1707
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A.
B.
C.
D.
E.
1708
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October 2016
A.
B.
C.
D.
E.
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1709
Postreading Test
1710
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October 2016
A.
B.
C.
D.
E.
central neurocytoma
choroid plexus papilloma
ependymoma
subependymal giant cell astrocytoma
subependymal nodule
A.
B.
C.
D.
E.
pituitary insufficiency
seeding to the spinal canal
seizure
sudden death
upward gaze palsy
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1711
Postreading Test
b 23. A 30-year-old woman is evaluated for right eye pain and blurred vision
over the past 2 weeks. Examination shows reduced visual acuity and a swollen
optic nerve in the right eye and a temporal field cut in the right eye. The rest
of the neurologic examination is normal. Sagittal T1 precontrast (A) and
postcontrast (B) sequences of her brain MRI are shown. Which is the
following is the most likely diagnosis?
A.
B.
C.
D.
E.
Churg-Strauss syndrome
CSF leak
Lyme disease
neurosarcoidosis
venous thrombosis
1712
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October 2016
b 25. A 72-year-old man is evaluated for the sudden onset of left hemiparesis.
On examination 3 hours after symptom onset, he has mild upper motor
neuron distribution weakness in the left upper limb. A fluid-attenuated
inversion recovery (FLAIR) MRI of the brain is obtained within 4 hours of the
event. What do the findings in this study indicate?
Reprinted with permission from Liebeskind DS. Imaging the future of stroke: I. Ischemia. Ann Neurol
2009;66(5):574Y590. doi:10.1002/ana.21787. B 2009 American Neurological Association.
onlinelibrary.wiley.com/doi/10.1002/ana.21787/abstract.
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1713
Postreading Test
A.
B.
C.
D.
E.
amyloid angiopathy
dilated Virchow-Robin spaces
lacunar infarcts
microemboli
vasculitis
b 28. High-resolution MRIs of the normal pituitary gland often show an area of
T1 hyperintensity, referred to as the pituitary bright spot. Which of the
following anatomic structures does this correspond to?
A.
B.
C.
D.
E.
1714
adenohypophysis
median eminence
neurohypophysis
pituitary stalk
Rathke cleft
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October 2016
A.
B.
C.
D.
E.
b 30. Which of the following time frames best approximates the average
duration that an acute multiple sclerosis (MS) lesion is expected to show
contrast enhancement on MRI?
A.
B.
C.
D.
E.
1 week
3 weeks
6 weeks
12 weeks
20 weeks
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1715
Postreading Test
A.
B.
C.
D.
E.
carotid-cavernous fistula
craniopharyngioma
dermoid cyst
pituitary apoplexy
pituitary macroadenoma
1716
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October 2016
b 33. A 57-year-old man is evaluated for numbness in his hands and feet and
imbalance that developed over the past 6 months. He has a history of
diabetes mellitus, hypertension, and a previous partial gastrectomy.
Examination shows a sensory ataxia with Romberg signs, areflexia, bilateral
Babinski signs, and absent joint position sense in the fingers and toes. MRI of
the cervical spine is shown. Serum methylmalonic acid levels are normal.
Which of the following is the most appropriate next test in this patient?
A.
B.
C.
D.
E.
antiYaquaporin-4 antibodies
antinuclear antibodies
serum angiotensin-converting enzyme
serum ceruloplasmin
serum vitamin D
b 34. A 54-year-old woman is seen for 1 week of right eye pain, a bloodshot
appearance to the right eye, and double vision. On examination, she has
proptosis, chemosis, and congestion of the right eye, with impairment of eye
movements in the horizontal and vertical directions. CT angiography of the
brain shows asymmetric contrast enhancement of the cavernous sinuses, with
more marked enhancement on the right; dilation of the right superior
ophthalmic vein is also seen. Which of the following is the most
likely diagnosis?
A.
B.
C.
D.
E.
carotid-cavernous fistula
right central retinal vein occlusion
right internal jugular vein thrombosis
temporal arteritis
unruptured right internal carotid artery aneurysm
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1717
Postreading Test
b 35. A 12-year-old boy is evaluated for headache, vomiting, and gait disturbance.
Examination shows papilledema, impaired upward gaze, and pupillary
light-near dissociation. Sagittal MRI using T2-weighted (A) and T1-weighted
(B) sequences are shown. Which of the following diagnoses
is most likely?
A.
B.
C.
D.
E.
histiocytosis
pilocytic astrocytoma
pineal cyst
pinealoma
teratoma
b 36. A 22-year-old man is evaluated for progressive gait disturbance and hand
paresthesia over the past 3 months. Examination shows a sensory ataxia and
severe proprioceptive loss in his hands and feet. MRI of the cervical spine
shows a T1-hypointense and T2-hyperintense cystic mass lesion with a
homogeneous contrast-enhancing nodule associated with dilated vessels and
a syrinx. Which of the following is the most likely diagnosis?
A.
B.
C.
D.
E.
1718
arteriovenous malformation
cavernous malformation
hemangioblastoma
myxopapillary ependymoma
pilocytic astrocytoma
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October 2016
b 37. A 31-year-old woman is seen for 3 days of worsening vision in the left eye
as well as pain with eye movements. She has had no prior episodes of
neurologic dysfunction. Examination is notable for 20/200 acuity in the left
eye, normal funduscopic appearance of the left optic nerve, and a relative
afferent pupillary defect on the left. Postcontrast fat-suppressed T1-weighted
MRI is shown. Which of the following is the most likely diagnosis?
A.
B.
C.
D.
E.
anterior cingulate
anterior temporal
dorsolateral prefrontal
medial parietal
ventrolateral prefrontal
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1719
Postreading Test
A.
B.
C.
D.
E.
arteriovenous malformation
cerebral vein occlusion
middle cerebral artery (MCA) thrombosis
subarachnoid hemorrhage
vasculitis
b 40. A 70-year-old man is referred for carotid ultrasonography after his primary
care provider heard a bruit over the left side of the neck. His ultrasound
shows elevated velocities in the 50% to 69% range. The presence of which of
the following ultrasound findings would be more suggestive of this plaque
being unstable and thus more likely to result in artery-to-artery embolism?
A.
B.
C.
D.
E.
1720
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October 2016