Block 13 Pace 1 Prt 2

17 Questions | Total Attempts: 289

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Block 13 Pace 1 Prt 2

Questions and Answers
  • 1. 
    An 11-year-old girl is brought to the pediatric neurosurgeon with headaches, nausea, and vomiting which have progressively worsened over the past month.  A head MRI scan reveals hydrocephalus and a posterior fossa mass.  The gross and microscopic appearance of the lesion is shown for your evaluation. Which of the following is the most likely diagnosis?
    • A. 

      Glioblastoma multiforme

    • B. 

      Pilocytic astrocytoma

    • C. 

      Fibrillary astrocytoma

    • D. 

      Ependymoma

    • E. 

      Medulloblastoma

  • 2. 
    Following an upper respiratory tract infection, a 35-year-old woman acutely developed ascending paralysis that eventually involved his respiratory muscles.  Nerve conduction velocity studies of affected nerves showed marked slowing. After receiving respiratory support by a ventilator for three weeks, corticosteroids and plasmaphoresis, she had eventual complete recovery of her respiratory and motor functioning.  Which of the following is the most likely diagnosis?
    • A. 

      Multiple sclerosis

    • B. 

      Charcot-Mary-Tooth disease

    • C. 

      Guillain-Barre syndrome

    • D. 

      Myasthenia gravis

    • E. 

      Rabies

  • 3. 
    A 48-year-old man with a long history of systemic hypertension experienced the sudden onset of a severe headache while at work.  Within a minute he became comatose and died before reaching the hospital.  Postmortem examination reveals changes shown for your evaluation. Which of the following is the most likely cause of his neurological abnormality?
    • A. 

      Rupture of Charcot-Bouchard aneurysm

    • B. 

      Anthrax

    • C. 

      Rupture of berry aneurysm

    • D. 

      Rupture of mycotic aneurysm

    • E. 

      Kaposi sarcoma metastasizing to subarachnoid space

  • 4. 
    A 33-year-old patient with severe hemophilia A develops symptoms of widespread cerebral inflammation. A biopsy of the brain reveals microglial nodules and the cells shown for your evaluation. If this patient is not treated, what is the expected clinical course?
    • A. 

      Chronic persistent disease with permanent disability and normal life expectancy

    • B. 

      Relentless progression to death, usually from secondary infection

    • C. 

      Limited acute disease with early remission

    • D. 

      Long term, severely debilitating disease with permanent disability but almost normal life expectancy

    • E. 

      Progression to glioblastoma multiforme

  • 5. 
    A 31-year-old woman experiences relapsing and remitting episodes of various neurologic deficits each lasting days at a time. Remissions are gradual and partial.  The frequency of relapses decreases over time. Her spinal fluid has a mildly elevated protein level, and there is increased gamma globulin with oligoclonal banding. What is the most likely pathologic finding in her brain?  
    • A. 

      Foci of demyelination

    • B. 

      Gelatinous exudate in subarachnoid space and small cysts in basal ganglia

    • C. 

      Asymmetric frontal and temporal lobe atrophy

    • D. 

      Glioblastoma multiforme crossing the corpus callosum

    • E. 

      Neuritic plaques and vascular amyloid deposition

  • 6. 
    A 68-year-old gardener presents to the emergency department with a 3-day history of fever, headache, myalgias, and weakness.  He is awake but is confused and oriented only to person.  Muscle strength is markedly diminished in the lower extremities and somewhat reduced in the upper extremities.  Deep tendon reflexes are absent throughout.  Acute serum and CSF samples revealed elevated levels of IgM antibodies to West Nile virus. What is the mode of transmission of the causative agent?
    • A. 

      Bite of an infected mosquito

    • B. 

      Bite of an infected tick

    • C. 

      Inhalation of soil contaminated with pigeon droppings

    • D. 

      Drinking fecally-contaminated water

    • E. 

      Handling an infected crow

  • 7. 
    A 45-year-old man is evaluated in the emergency department with a fever, headache, stiff neck, and mild confusion. He had returned 2 days earlier from a 2-week medical mission trip to the Ozark Mountains. During the last few days of the trip, he developed an earache which he self-treated with acetaminophen. On physical examination, his temperature is 39.4°C (103.0°F), blood pressure is 128/72 mm Hg, pulse rate is 105/minute, and respiratory rate is 20/minute. He exhibits both Kernig and Brudinzki signs. No skin lesions are noted. Lab studies indicate a leukocytosis with a left shift. CSF analysis shows a leukocytic pleocytosis with 99% neutrophils, a glucose concentration of 20 mg/dL (normal = 60-70 mg/dL), and a protein level of 200 mg/dL (normal = <40 mg/dL). What is the most likely causative agent of this patient’s illness?
    • A. 

      Neisseria meningitidis

    • B. 

      Herpes simplex virus

    • C. 

      Streptococcus pneumoniae

    • D. 

      Streptococcus agalactiae

    • E. 

      Listeria monocytogenes

  • 8. 
    A 22-year-old medical student presents with problems of poor attention in class and difficulty in concentration and focusing. He would spend several hours reviewing a lecture as he finds he is easily distracted. He had in the past, since he was a child, problems with focusing on tasks and was seen by a pediatrician when he was six years old who told his parents that she suspected that he had an attention deficit disorder. His parents refused treatment as they felt that medication would affect his growth. He did fairly well in his undergraduate studies obtaining a grade point average of 3.6 but performed poorly on the verbal component of the MCAT.  He is now requesting testing to determine whether he does have an attention deficit disorder. Given his history the physician feels fairly certain that his test results would be positive for Attention Deficit Hyperactive disorder, Inattentive type. What would be the basis for the physician’s presumptive diagnosis?
    • A. 

      History of poor concentration

    • B. 

      History of easy distractibility

    • C. 

      Poor performance on the verbal component of the MCAT

    • D. 

      History of focusing problems when he was six years old

    • E. 

      History of poor attention in class

  • 9. 
    The patient is a 37-year-old woman with three young children. She describes having intense fear of going in the basement of her house after a recent strong earthquake. She is also now afraid when using the elevator to get to her work office on the 21st floor. She feels emotionally numb and sometimes like she is just watching herself go through the day; she perspires heavily and says the lights seem to be getting brighter and darker at times.  This has been going on for the last two weeks, and does not seem to be getting better or worse during that time. Based on the reported symptoms, which is the best DSM IV classification at this time?
    • A. 

      Generalized Anxiety Disorder

    • B. 

      Specific Phobia

    • C. 

      Agoraphobia

    • D. 

      Social phobia

    • E. 

      Acute Stress Reaction

  • 10. 
    The patient has had symptoms of chronic worrying since he was in high school. At that time he was in a building that collapsed during hurricane Katrina. He re-experiences that time of his life, constantly going over what might go wrong and how to avoid it in the future. He is generally less functional at work and in leisure time because of this constant distraction. He often over reacts to loud noises and has trouble losing focus in traffic situations. In many situations he behaves completely normally. Which of the following best describes the patient?
    • A. 

      Generalized Anxiety Disorder

    • B. 

      Agoraphobia

    • C. 

      Social Phobia

    • D. 

      Post Traumatic Stress Disorder

    • E. 

      Obsessive-Compulsive Disorder

  • 11. 
    Mr. Davies is 60-years-old. He woke at three a.m. with the worst unilateral headache he’d had to date. His nose was stuffy and eyelid drooping on that side. His face was flushed. He had had a similar headache, but not as severe two days before and also the previous week. In the past these headaches have only lasted a ½ hour, so Mr. Davies felt it wasn’t worth calling the doctor. About every four or five months Mr. Davies gets a week or so of these bad headaches and then they disappear until the next time. What is the most accurate diagnosis of Mr. Davies headache?
    • A. 

      Cluster headaches

    • B. 

      Migraine with aura

    • C. 

      Complicated migraine

    • D. 

      Trigeminal neuralgia

    • E. 

      Muscle tension headache

  • 12. 
    A 23-year-old female has been doing military maneuvers in the desert all day.  She returns to base and then is required to attend a parade which involved standing at attention in the sun for half an hour. She suddenly collapses and passes out. She recovers quickly and apart from feeling a little shaky is behaving normally. What is she most likely suffering from?
    • A. 

      Vertebrobasilar insufficiency

    • B. 

      Vascular syncope

    • C. 

      Akinetic drop attack

    • D. 

      Generalized seizure

    • E. 

      Heat stroke

  • 13. 
    A 68-yo-male presents with a gradually progressive memory difficulties over 8 years, is now unable to dress properly without his wife laying out his clothes. A diagnosis is made clinically after an unrevealing work up. What is the most likely pathological finding to confirm the clinical diagnosis?
    • A. 

      Abnormal Tau protein

    • B. 

      Abnormal APOE4

    • C. 

      Plaques and tangles

    • D. 

      Frontal atrophy

    • E. 

      Frontal and temporal atrophy

  • 14. 
    A 55-year-old right-handed male presents with a sudden right-sided weakness of the arm more than the leg. His speech is sparse, with difficulty repeating and coming up with the correct words. There is a past history of uncontrolled hypertension and diabetes. What is the clinical / pathophysiological correlation most fitting with this case?
    • A. 

      An anterior cerebral artery distribution stroke

    • B. 

      A middle cerebral artery distribution stroke with an anterior (Broca’s type) aphasia

    • C. 

      An hemorrhagic stroke, based on the risk factors and his race

    • D. 

      A lacunar stroke because of the history of hypertension

    • E. 

      A border-zone stroke

  • 15. 
    A 33-year-old woman, 2 days post-surgery, becomes agitated, diaphoretic, tachycardic and begins to act inappropriately, becoming violent, to the point of injuring herself and her attendants while in her hospital bed. The full medical work-up is unrevealing. How is this patient best treated?
    • A. 

      Treat the dysautonomia

    • B. 

      Treat the agitation

    • C. 

      Treat the underlying problem

    • D. 

      Treat each symptom.

    • E. 

      Avoid treating the symptoms

  • 16. 
    A 3-year-oldboy is admitted to the pediatric unit because of failure to thrive, irritability and recurrent morning vomiting.  The admitting pediatrician notes nystagmus and a pediatric ophthalmologist finds a partial visual field deficit in the right eye. An MRI with gadolinium is performed. Where is the most likely location of a mass lesion?
    • A. 

      Pons

    • B. 

      Cerebellar vermis

    • C. 

      Pineal gland

    • D. 

      Hypothalamus

    • E. 

      Fourth ventricle

  • 17. 
    A 42-year-old woman presents with a history of type II diabetes. She complains of dysphoric mood, difficulty concentrating, sleep disturbance, appetite disturbance, back pain, headache and fatigue for the past three weeks.  What is the most likely type of mood disorder exhibited by this patient?  
    • A. 

      Cyclothymic disorder

    • B. 

      Dysthymic disorder

    • C. 

      Melancholia

    • D. 

      Mood disorder due to a general medical condition

    • E. 

      Major depressive disorder

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