The Quizzes about Diseases of the Nervous System – Part 1 (20 test)

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The Quizzes about Diseases of the Nervous System – Part 1 (20 test)
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Select the ONE answer that is BEST in each case.

A 69-year-old woman presents to the clinic with memory difficulty. The patient’s daughter is concerned because she is having difficulty doing her finances, such as paying bills. Memory impairment testing reveals the poor ability to generate lists of words or copy diagrams (intersecting pentagons). Her remaining physical examination is normal. Which of the following anatomic findings is most likely with her condition?

Alzheimer’s disease can be quite diffuse, but there is particular involvement of the medial temporal lobes and cortical association areas. The atrophy of the hippocampus is particularly marked. Microscopic examination reveals neurofibrillary tangles and amyloid plaques.

 

See all quizzes of  the Diseases of the Nervous System at here:

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1. A 69-year-old woman presents to the clinic with memory difficulty. The patient’s daughter is concerned because she is having difficulty doing her finances, such as paying bills. Memory impairment testing reveals the poor ability to generate lists of words or copy diagrams (intersecting pentagons). Her remaining physical examination is normal. Which of the following anatomic findings is most likely with her condition?
(A) atrophy of the medial temporal lobes
(B) atrophy of the entire frontal and temporal lobes
(C) cranial nerve involvement
(D) transient episodes of hemiplegia
(E) atrophy of the caudate
2. A 38-year-old man presents with involuntary facial grimacing, shrugging of the shoulders, and jerking movements of the limb. His father was similarly affected. There is also a history of mood changes for the past 3 months. On examination, he appears restless with intermittent slow movements of his hands and face. He has difficulty performing rapid finger movements, and tone is decreased in the upper and lower limbs. Which of the following is most likely to represent the progression of his illness?

(A) a normal life span
(B) a 50% chance of only male children being similarly affected
(C) mental deterioration
(D) eventual development of rigidity
(E) development of hemiparesis

3. An 18-year-old woman has periodic episodes that begin with severely decreased vision, followed by ataxia, dysarthria, and tinnitus. The symptoms last for 30 minutes and are then followed by a throbbing occipital headache. Which of the following is the most likely diagnosis?
(A) vertebral-basilar insufficiency
(B) chronic basilar artery dissection
(C) classic migraine
(D) ophthalmoplegic migraine
(E) basilar migraine
4. A 6-month-old child presents with recurrent seizures and poor development. The evaluation reveals a baby with hydrocephalus, impaired movement of the extremities, hypotonia, and retinal abnormalities. A computerized tomography (CT) scan demonstrates large ventricles and calcified lesions. Which of the following is the most likely diagnosis?
(A) Tay-Sachs disease
(B) congenital hydrocephalus
(C) kernicterus
(D) toxoplasmosis
(E) congenital neurosyphilis
5. A74-year-old woman develops acute neurologic symptoms and presents to the emergency room. An urgent magnetic resonance imaging (MRI) scan demonstrates acute occlusion in the right posterior cerebral artery. Which of the following clinical symptoms is she most likely to have?
(A) homonymous hemianopia
(B) total blindness
(C) expressive aphasia
(D) ataxia and dysarthria
(E) a right-sided hemiplegia
6. A 53-year-old man complains of clumsiness with both hands, like having difficulty doing up buttons or using his keys. Physical examination reveals fasciculations of his thigh and forearm muscles; diffuse muscle weakness, loss of muscle bulk, and increased tone in the upper and lower limbs. There is generalized hyperreflexia, and positive Babinski signs bilaterally. Which of the following is the most likely natural progression of this condition?
(A) a long history of remissions and exacerbations
(B) sensory loss in the distribution of peripheral nerves
(C) focal seizures
(D) a progressively downhill course
(E) cogwheel rigidity
7. A 38-year-old man presents with involuntary facial grimacing, shrugging of the shoulders, and jerking movements of the limb. His father was similarly affected. There is also a history of mood changes for the past 3 months. On examination, he appears restless with intermittent slow movements of his hands and face. He has difficulty performing rapid finger movements, and tone is decreased in the upper and lower limbs. Which of the following treatments is helpful in suppressing the movements?
(A) gamma-aminobutyric acid (GABA)- mimetic agents
(B) inhibitors of GABA metabolism
(C) cholinergic agents
(D) dopamine receptor blockers

(E) centrally acting cholinesterase inhibitors

8. A 22-year-old woman presents with acute vision loss and pain in the left eye, but no other symptoms. On examination she appears well, visual acuity is not possible, and she can only perceive movement and bright light. The direct papillary reflex is absent but the indirect (consensual) response is normal. The optic disc is edematous. Which of the following symptoms is also most likely present in patients with this condition?
(A) limb weakness
(B) hemiplegia
(C) cervical myelopathy
(D) sphincter impairment
(E) seizures
9. A 63-year-old man developed a transient episode of vertigo, slurred speech, diplopia, and paresthesias. He is symptom-free now, and clinical examination is entirely normal. His past medical history is significant for hypertension and dyslipidemia. Which of the following is the most likely cause for symptoms?
(A) posterior circulation transient ischemic attack (TIA)
(B) anterior communicating artery aneurysm
(C) hypertensive encephalopathy
(D) pseudobulbar palsy
(E) occlusion of the middle cerebral artery
10. A 75-year-old woman presents with symptoms of visual change and facial weakness. On examination, the pupils are equal and reactive to light, the fundi appear normal, and there is a right homonymous visual field defect. Which of the following is the most likely cause of the right homonymous hemianopia?
(A) right optic nerve
(B) chiasm
(C) right optic radiations
(D) right occipital lobe
(E) left optic radiations
11. A 10-year-old boy has multiple tan-colored patches on his skin, and freckle-like skin changes in his armpit area. The rest of clinical examination is normal. Which of the following conditions is also found in patients with this disorder as they get older?
(A) bilateral eighth nerve tumors
(B) irregular small pupils
(C) multiple cutaneous and subcutaneous tumors
(D) cataracts
(E) hip involvement
12. A 44-year-old man presents with involuntary movements of his face, shoulders, and arms. His father had a similar condition. There is also a history of mood changes for the past 6 months. On examination, he appears restless with intermittent slow movements of his hands and face. He has difficulty performing rapid finger movements, and tone is decreased in the upper and lower limbs. Which of the following is the most likely diagnosis?
(A) Parkinson’s disease
(B) Huntington’s chorea
(C) amyotrophic lateral sclerosis (ALS)
(D) spinal muscular atrophy
(E) Sydenham’s chorea
13. A 56-year-old man is brought to the emergency department by his wife because of memory loss and difficulty walking. She has noticed personality changes, truancy from work, and lack of personal care over the past 1 year. On examination he appears unkempt, smells of urine, and is uncooperative. He cannot recall the date or season, and gets angry when asked questions. His answers are often fabricated when checked with his wife. The blood pressure is 150/90 mm Hg, pulse 100/min, and he is diaphoretic and tremulous. His gait is wide based, and motor strength and reflexes are normal. His ocular movements are normal but there is nystagmus on lateral gaze. In the past he has had multiple admissions for alcohol withdrawal. Which of the following is the most appropriate next step in management?

(A) prophylactic phenytoin administration
(B) prophylactic diazepam administration
(C) prophylactic carbamazepine administration
(D) calcium administration
(E) steroid administration

14. A 60-year-old man with diabetes acutely develops double vision and discomfort in his left eye. On examination, there is ptosis of the left eyelid, the eye is rotated down and out, and the pupil is 3 mm and reactive to light. The right eye is normal. Which of the following is the most likely diagnosis?
(A) fourth nerve palsy
(B) diabetic autonomic neuropathy
(C) third nerve palsy
(D) sixth nerve palsy
(E) seventh nerve palsy
15. A 48-year-old man complains of recurrent episodes of sudden-onset dizziness. He notices an abrupt onset of a spinning sensation when sitting up or lying down in bed. The symptoms last for 30 seconds and then resolve completely. He has no hearing change or other neurologic symptoms, and his physical examination is completely normal. A Dix-Hallpike maneuver reproduces his symptoms. Which of the following is the most likely mechanism for his vertigo symptoms?
(A) basilar migraine
(B) brain stem ischemic events
(C) benign cerebellar tumors
(D) calcium debris (calcium carbonate crystals) in the semicircular canals
(E) Meniere’s disease
16. A 40-year-old man is injured in a car accident and fractures his left elbow. He now complains of numbness of his fourth and fifth fingers, and weakness in his hand grip. Neurologic findings confirm weakness of handgrip with weakness of finger abduction and adduction, and decreased sensation over the fifth finger and  lateral aspect of fourth finger. Which of the following is the most likely diagnosis?
(A) ulnar nerve injury
(B) radial nerve injury
(C) median nerve injury
(D) carpal tunnel syndrome
(E) axillary nerve injury
17. A 31-year-old woman complains of excessive sleepiness during the daytime for years despite adequate nighttime sleep. She has episodes of intense drowsiness three to four times a day, even when at work or while eating meals. She has sought medical attention in the past, after falling asleep while driving. She is slender and otherwise healthy and on no medications. Which of the following treatments is most likely indicated for her condition?
(A) a device providing continuous positive airway pressure (CPAP) at night
(B) oral surgery
(C) tracheostomy
(D) amphetamines
(E) benzodiazepines at bedtime
18. A 43-year-old man is referred from the emergency department with memory loss and difficulty walking. He was brought in by his wife who has noticed personality changes, truancy from work, and lack of personal care over the past 2 years. On examination he appears unkempt, smells of urine, and is uncooperative. He cannot recall the date or season, and gets angry when asked questions. His answers are often fabricated when checked with his wife. His gait is wide-based, and there is loss of sensation in his feet up to the shins. His motor strength and reflexes are normal. His ocular movements are normal and there is no nystagmus. In the past he has had multiple admissions for alcohol withdrawal. Which of the following is the most likely diagnosis?
(A) Wernicke’s encephalopathy
(B) Wernicke-Korsakoff syndrome
(C) Alzheimer’s dementia
(D) Charcot-Marie-Tooth disease
(E) vascular dementia
19. A 59-year-old woman has numbness and tingling in her feet. On examination, there are signs of involvement of the peripheral nerves in the form of decreased sensation, motor weakness, and distal reflex loss. The findings are symmetric. Which of the following medical conditions is most likely to explain her peripheral nerve findings?
(A) heart disease
(B) dermatomyositis
(C) hypothyroidism
(D) diabetes mellitus
(E) adrenal insufficiency
20. A 94-year-old man presents with progressive headaches, light-headedness, drowsiness, and unsteady gait over 6 weeks. On examination, his blood pressure is 160/90 mm Hg, pulse 70/min, lungs clear, and he has no focal weakness. His gait is unsteady but sensation in the feet is normal. A CT scan reveals a hyperintense clot over the left cerebral cortex. Which of the following is the most likely cause for this clot?
(A) is venous in origin
(B) is arterial in origin
(C) is from injury to the middle meningeal artery
(D) is from a subarachnoid hemorrhage
(E) is from injury to the middle cerebral artery

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