DIRECTIONS: Each item below contains a question or incomplete statement followed by suggested responses. Select the one best response to each question.
456. A 35-year-old man comes to your office with a complaint of recent development of headaches that are generalized in nature. He is accompanied by his wife who recently returned from a trip. She tells you that her husband has been somewhat confused at times and clumsy. He does not confirm this, but he does report that he has been short of breath at times. On examination, he is mildly tachycardia and there is a reddish appearance to his mucous membranes, which is subtle. The only recent new medical problem identified is that the patient was in a motor vehicle accident in which he was struck in the rear end, and it left him with a sore neck. The most likely diagnosis is a. Acquired spinal stenosis (cervical)
b. Normal pressure hydrocephalus c. Carbon monoxide poisoning d. Cocaine toxicity e. Muscle tension
457. A 40-year-old man is noted to have miosis of the right eye and ipsi-lateral ptosis. He reports that he has noted that this side of his face is not sweating when he is working recently. The most cause of this clinical picture may be a. Pancoast tumor b. Brainstem CVA
c. Dissection of the carotid artery d. Idiopathic
458. A 55-year-old male describes bilateral pain in his lower back and legs with prolonged standing while working on an assembly line. Whenever he sits down and takes a break, he gets some relief, but it recurs when he resumes his job. No other inciting events can be identified. The most likely cause of this problem is a. Degenerative joint disease b. Degenerative disk disease c. Peripheral vascular disease d. Lumbar spinal stenosis
459. An elderly woman is seen at your office with a complaint of loss of vision in her left eye, which had been transient on a couple of occasions but is now persisting. She has been seen recently at urgent care centers for multiple complaints including generalized fatigue, left-sided dull boring headaches with occasional sharp jabbing sensations, and arthritic complaint in the hips. In addition, she reports some recent loss of 7 to 10 pounds. The only remarkable finding on the routine labs obtained from her prior evaluations is an elevated alkaline phosphatase. You determine that the likely cause of her condition is a. Glaucoma b. Brain tumor arising anterior to the optic chiasm c. Optic neuritis d. Temporal arteritis
460. A middle-aged female arrives at your office after not seeing a physician for many years to have a general physical performed. Overall, she appears healthy but a poorly reacting left pupil is noted when a pen light is used. Instillation of a weak solution of pilocarpine leads to constriction of the pupil quickly. Your diagnosis is a. Argyll Robertson pupil b. Adie's tonic pupil c. Trauma-induced pupil dysfunction d. Horner's syndrome
461. In the above patient, what other abnormality on physical would be consistent with the diagnosis?
a. Ptosis b. Decreased visual acuity on Snellen's chart c. Hyporeflexia in the lower extremities d. Ataxic gait
462. While in the ICU, you are called to your patient's bedside because of the development of seizure activity in a ventilator patient with nosocomial pneumonia. You review the situation including the medication record. The patient is currently receiving dopamine, one-half normal saline, imipenem/ cilastatin, tobramycin, lisinopril, clonidine patch, and famotidine. The laboratory test results from this morning show normal electrolytes, except for a mildly elevated creatinine of 2.4 that is chronic, and CBC shows an improving white blood count of 15,000. After stopping the acute seizure event, you determine the next step in preventing further seizures is a. Stop dopamine b. Stop clonidine c. Intravenous phenytoin d. Change antibiotic coverage e. CT of the head
463. Two days after admission, a 57-year-old man suddenly has a seizure. He was undergoing evaluation for substernal chest pain. The nursing staff noted that he seemed to be a little shaky since shortly after arrival on the floor. He has no history of seizures and a stat CT of the head performed during the postictal state was normal. Laboratory results had shown an MCV of 101 (elevated) and his AST was mildly elevated (one and one-half normal). In this patient, the most likely imbalance that would contribute to this event would be a. Folate deficiency b. Fasting hypoglycemia c. Hypomagnesemia d. Thiamine deficiency e. Vitamin B12 deficiency
464. A 25-year-old man with a high-frequency fine tremor that may be difficult to see grossly has a. Parkinson's disease b. Essential tremor c. Asterixis d. Hyperthyroidism e. Drug-related tremor
465. A 64-year-old man complains of a resting tremor that lessens with intentional movement and that causes him substantial embarrassment.
What is the likely cause?
466. The tremor associated with hepatic encephalopathy is a. Resting tremor b. Essential tremor c. Asterixis d. Very high frequency e. Drug related
467. The tremor of which condition lessens with consumption of small amounts of alcohol a. Parkinson's disease b. Essential tremor c. Asterixis d. Hyperthyroidism e. Drug-related tremor
468. A 65-year-old woman is seen for evaluation of dementia. On examination, you note that her left pupil does not react well to light. When she follows your finger with her eyes, as you approach the bridge of her nose, you note the left pupil to constrict equally as well as the right one. The most important test to order at this point would be a. Titer for Lyme disease
469. Which of the following muscle diseases with weakness is an autoimmune disorder?
Becker muscular dystrophy Myotonic dystrophy
Glycogen storage disorder (acid maltase deficiency) Duchenne muscular dystrophy Myasthenia gravis
470. A 68-year-old man comes to your office with a complaint of right-sided jaw pain that occurs about half way through his meal. He has seen his dentist already and no abnormality was found. X-rays of the area were taken and they also were unremarkable. The next step in his workup should be
CT of the region
Calcium level Carotid duplex
471. Which statement is true regarding the optic neuropathy that occurs with combined use of cigarettes and alcohol?
472. Entrapment of the median nerve causing carpal tunnel syndrome and if severe, muscle wasting in the thenar eminence of the hand, is associated with which of the following diseases?
473. A 75-year-old man is brought to your office by his son with concerns over developing dementia problems. Previously, the patient had been well and was forced to retire from his job a few months ago because of worsening arthritis symptoms limiting his mobility. He has been a widower for 7 months and he lives alone. His family is worried about his safety in view of these changes. The likely cause of this dementia picture is a. HIV related b. B12 deficiency c. Depression d. Multi-infarct dementia
474. A 35-year-old woman comes to your office complaining of weakness in her limbs and fatigability of her muscles, which, it seems to her, lessens after she rests. Sometimes she does not have any muscle weakness, for months at a time, and then she does; all this has been happening to her for the past few years. She tells you that what bothers her most is the "droopi-ness" of her eyelids. Which one procedure provides definitive confirmation of the diagnosis?
a. Single-fiber electromyography b. CT scan or MRI of the head c. Antiacetylcholine receptor radioimmunoassay d. Edrophonium chloride test e. Electroencephalogram (EEG)
475. A 38-year-old man presents to the emergency room with the sudden onset of a severe headache while chopping wood. This is the worst pain he has ever experienced, and it is accompanied by photophobia and vomiting. Which procedure(s) provide the best chance of making the diagnosis?
a. CT scan of the head b. Lumbar puncture c. CT scan of the head and lumbar puncture d. ECG, lumbar puncture, and x-rays of the skull e. Pneumoencephalogram
476. Excitatory neurotransmitters such as acetylcholine and glutamate perform which of the following functions?
a. Open cation channels and allow influx of Na+ or Ca++.
b. Generate inhibitory postsynaptic potentials c. Activate mitochondria d. Regulate intracellular K+
e. Carry impulses between peripheral nerves only
477. A 25-year-old graduate student is injured in a fall during a weekend rock climbing expedition. There is serious damage to the peripheral nerves in his leg. Which of the following can be expected to occur?
a. Denervated muscles will hypertrophy b. Individual muscle fibers will not be able to contract spontaneously c. Groups of muscle fibers will not be able to spontaneously discharge d. Normal motor function may never return e. Muscle bulk may increase by one-half within 2 to 3 months
478. Weakness is caused by diseased anterior horn cells in which of the following disorders?
a. Myasthenia gravis b. Botulism c. Amyotrophic lateral sclerosis d. Aminoglycoside antibiotic-associated weakness e. Lambert-Eaton myasthenic syndrome
479. A 45-year-old man who has consumed excess alcohol for at least 20 years is seen for evaluation of progressive difficulty in walking. He has an ataxic gait and his muscles are generally hypotonic. He has an intention tremor in his arms and legs and he also demonstrates "past pointing." His primary brain pathology will be found in the a. Occipital cortex b. Temporal lobe c. Cerebellum d. Brainstem e. Frontal cortex
480. A patient who has been diabetic for 15 years comes to your office complaining of a burning or tingling sensation in both of his feet and the lower aspects of both legs, which bothers him especially at night. His most likely diagnosis is a. Mononeuropathy b. Brown-Sequard's syndrome c. Polyneuropathy d. Mononeuropathy multiplex e. Radiculopathy
481. A moderately obese factory worker who stands for long periods of time begins to experience pain and a severe burning sensation that is localized over the left anterior lateral thigh. This patient has a a. Mononeuropathy b. Brown-Sequard's syndrome c. Polyneuropathy d. Mononeuropathy multiplex e. Radiculopathy
482. A man who was stabbed in the back during a fight is brought to the emergency room. On examination you find impaired pain and temperature sensation in one leg and impaired proprioception and vibration sense in the opposite leg. These findings are descriptive of a a. Mononeuropathy b. Brown-Sequard's syndrome c. Polyneuropathy d. Mononeuropathy multiplex e. Radiculopathy
483. A 38-year-old woman with rheumatoid arthritis develops worse joint pain and also pain and paresthesias in scattered locations in both arms and both legs. Her sedimentation rate increases significantly and you diagnose vasculitis causing a. Mononeuropathy b. Brown-Sequard's syndrome c. Polyneuropathy d. Mononeuropathy multiplex e. Radiculopathy
484. A 55-year-old man who has worked for many years as a stevedore develops pain and weakness in the lower back that radiates down the pos-terolateral thigh and lower aspect of the leg. This is characterized as a. Mononeuropathy b. Brown-Sequard's syndrome c. Polyneuropathy d. Mononeuropathy multiplex e. Radiculopathy
a. Left central scotoma b. Bitemporal hemianopsia c. Left nasal hemianopsia d. Left homonymous hemianopsia e. Completely blind left eye
486. A 2-year-old boy is brought to your office by his parents who believe he may not have normal hearing. You determine that he has congenital damage to the left cochlea. This is classified as a kind of a. Conductive deafness b. Sensorineural deafness c. Central deafness d. Tinnitus e. Presbycusis
487. A 77-year-old man complains to you of an annoying buzzing sound in his right ear that bothers him mostly at night. This is classified as a. Conductive deafness b. Sensorineural deafness c. Central deafness d. Tinnitus e. Presbycusis
488. Deafness due to disease of the cochlear nuclei or auditory pathways is classified as a. Conductive deafness b. Sensorineural deafness c. Central deafness d. Tinnitus e. Presbycusis
489. A teenage girl presents for evaluation of hearing loss in her right ear. She has a history of at least 12 episodes of otitis media as a child; at least one time she perforated her ear drum. Her hearing loss is classified as a. Conductive deafness b. Sensorineural deafness c. Central deafness d. Tinnitus e. Presbycusis
490. Which of the following clinical diagnoses is most often accompanied by coma?
a. Transient ischemic strokes b. Creutzfeldt-Jakob disease or multi-infarct dementia c. Cerebral hemorrhage, either subarachnoid or intracerebral d. Amyotrophic lateral sclerosis e. Small lacunar infarcts
491. Patients commonly complain of "dizziness." This symptom is a. A well-defined sensation of one's environment spinning around b. Usually accompanied by the physical finding of nystagmus c. Usually accompanied by hearing loss d. A loosely defined and nonspecific symptom of light-headedness or weakness or spinning e. A specific sign of impending stroke
492. A 70-year-old man is brought to the ER because of sudden onset of right arm weakness and inability to understand speech. This speech problem is called a. Apraxia b. Aphasia c. Abulia d. Anomia e. Alexia
493. A patient whom you have diagnosed with Alzheimer's disease is increasingly unable to retrieve from memory or to appropriately use previously learned words. This disorder is called a. Apraxia b. Aphasia c. Abulia d. Anomia e. Alexia
494. A 50-year-old man who is an alcoholic is severely injured in a barroom brawl. He sustains a major injury to the frontal lobes of his brain. Subsequently, he always seems apathetic and unemotional. This disorder is called a. Apraxia b. Aphasia c. Abulia d. Anomia e. Alexia
495. The inability to read printed words is known as a. Apraxia b. Aphasia c. Abulia d. Anomia e. Alexia
496. A 30-year-old woman undergoes surgery for a very large, but fortunately benign, brain tumor. For 2 days after the surgery she is unable to perform certain previously learned motor functions. This disorder is called a. Apraxia b. Aphasia c. Abulia d. Anomia e. Alexia
497. Abnormalities in the cytosolic copper-zinc superoxide dismutase (SOD1) gene on chromosome 21 have been identified as factors in the pathophysiology of which degenerative disorder?
a. Parkinson's disease b. Amyotrophic lateral sclerosis c. Huntington's chorea d. Alzheimer's Disease e. Tuberous sclerosis
498. An 8-year-old girl is noted to be having frequent "staring" spells during which she seems oblivious to her surroundings. She seems to suddenly return to awareness without realizing that she has been temporarily "out." The most likely finding on a full evaluation would be a. Three per second (3-Hz) spike and wave activity on EEG
b. Abnormal reflexes in her lower extremities c. An abnormal CT scan showing an occipital mass d. An abnormal MRI showing demyelination e. An abnormal mental status examination showing disorientation to time
499. Which clinical scenario best describes a patient with midstage dementia of the Alzheimer's type?
a. A patient has gradually developed memory deficits over the past four or five years; the deficits worsen each time he has a "spell," described by the family as "little strokes that get better in a few days"
b. A patient has had Parkinson's disease for years, and after becoming nearly immobile, he is also noted to have memory and language deficits c. A patient has become progressively more withdrawn and shows deficits in short- and long-term memory; these deficits have been noticed by the family since the patient's wife and his last sibling died about 5 months ago d. A patient became socially withdrawn a couple of years ago because he could not keep up with his friends' activities such as golf and bridge; now he is getting lost whenever he leaves his house e. A long-term, often homeless, alcoholic becomes progressively disoriented and confused, and the condition cannot be reversed by a move to a nursing home where he receives adequate nutrition and medical care
500. Which cerebral artery is blocked in an ischemic stroke that presents with the following symptoms: aphasia, right hemiparesis, and right arm numbness?
a. Right anterior cerebral b. Right middle cerebral c. Right proximal posterior cerebral d. Left anterior cerebral e. Left middle cerebral
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