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Select the ONE answer that is BEST in each case.
A 68-year-old man has many months history of progressive hearing loss, unsteady gait, tinnitus, and facial pain. An MRI scan reveals a tumor at the cerebellopontine angle. Which of the following cranial nerves is this tumor most likely to affect?
An acoustic neuroma is most likely to lead to a palsy of the eighth cranial nerve. Deafness, headache, ataxia, tinnitus, and diplopia are seen, as well as facial paresthesias. Acoustic neuromas represent 5–10% of all intracranial tumors. They develop from Schwann cells and generally grow very slowly. They may be very large before symptoms develop.
See all quizzes of the Diseases of the Nervous System at here:
|21. A 68-year-old man has many months history of progressive hearing loss, unsteady gait, tinnitus, and facial pain. An MRI scan reveals a tumor at the cerebellopontine angle. Which of the following cranial nerves is this tumor most likely to affect?
(A) fourth cranial nerve
|22. A 27-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 pupillary reflex is absent but the indirect (consensual) response is normal. The optic disc is edematous. An example of the pathologic changes seen in her optic nerve are shown in Fig. 7–1 a. It shows a plaque of demyelination in the optic nerve as compared to a normal sample in Fig. 7–1 b. Which of the following is the most likely diagnosis?
(A) diabetic microvascular disease
(D) multiple sclerosis
(E) Creutzfeldt-Jakob disease
|23. A 25-year-old man complains of excessive sleepiness during the daytime for years despite adequate nighttime sleep. He has sought medical attention after falling asleep while driving. He is slender and otherwise healthy and on no medications. Which of the following symptoms might he also complain about?
(A) excessive snoring (wife’s report)
(B) automatic behavior (wife’s report)
(C) restless sleep (wife’s report)
(E) morning headache
|24. A 17-year-old woman presents with symptoms of a fine tremor of her hands. The tremor is best seen when her hands are stretched out. She is not on any medications and reports no alcohol use. Which of the following is the most likely diagnosis?
(B) marijuana use
(E) iron overdose
|25. A 19-year-old man has had progressive ataxia of gait and great difficulty in running. In the past year, he has developed hand clumsiness. Physical examination reveals pes cavus, kyphoscoliosis, and both cerebellar and sensory changes in the legs. There is a positive family history of Friedreich’s ataxia. Where are the pathologic changes seen in this condition most likely to be found?
(A) spinal cord tracts
(B) basal ganglia
(C) cerebral cortex
(D) peripheral autonomic nerves
(E) peripheral motor nerves
|26. A 24-year-old man presents with mild jaundice, tremor, and personality changes. Examination reveals slowness of finger movement, rigidity, and coarse tremor of the outstretched hands. As well there is abnormal slow movement of the tongue and pharynx resulting in a change in speech and occasional difficulty swallowing. He is icteric, the liver span is 10 cm, and no spleen is palpable. Which of the following findings is most likely seen in this condition?
(A) a reduction of copper excretion in the urine
(B) an increase of the serum ceruloplasmin content
(C) no renal involvement
(D) retention of normal neurologic movements
(E) a peculiar greenish-brown pigmentation of the cornea
|27. A 52-year-old man complains of episodes of severe unilateral, stabbing facial pain that is intermittent for several hours, and then disappears for several days. The pain is describes as “electric shock-like” and only lasts a few seconds. Physical examination of the face and mouth is entirely normal. Which of the following treatments is most effective for this condition?
(E) lidocaine (Xylocaine) gel
|28. A 63-year-old woman develops symptoms of nausea, vomiting, and dizziness, which she describes as a to-and-fro movement of the room like as if she is on a boat. Which of the following findings suggests the vertigo is central in origin?
(B) symptoms are more protracted but less severe
(C) unidirectional nystagmus
(D) visual fixation inhibits vertigo and nystagmus
(E) spinning sensation is toward the fast phase of nystagmus
|29. A 30-year-old woman complains of double vision, and easy fatigue with exercise. The fatigue improves with resting, but it is interfering with her work. Examination reveals ptosis and impaired eye movements with normal pupillary response. The double vision is brought out by asking her to look at the ceiling, and after a sustained interval, the eyes slowly drift down. Which of the following is the most likely diagnosis?
(A) optic atrophy
(B) ophthalmic zoster
(C) paralysis agitans
(D) Horner syndrome
(E) myasthenia gravis
|30. A 47-year-old woman presents with increasing headaches and visual changes. On examination, her pupils are normal and reactive to light, the extraocular movements are normal, and there are visual field defects of the outer half in both eyes (bitemporal hemianopsia). Which of the following is the most likely diagnosis?
(A) pituitary adenoma
(B) falx meningioma
(D) aneurysm of the internal carotid artery
|31. A 45-year-old man presents with weakness and fasciculations in his arms and legs. His cranial nerves are normal, but there is weakness of his left handgrip and right leg quadriceps with loss of muscle bulk. There are obvious fasciculations over the left forearm and right thigh. Tone is increased in the arms and legs and the reflexes are brisk. Which of the following is the most likely diagnosis?
(A) amyotrophic lateral sclerosis (ALS)
(B) myotonic muscular dystrophy
(C) amyotonia congenita
(D) tabes dorsalis
|32. Which of the following is the most likely finding in a 79-year-old woman with Parkinson’s disease?
(A) constant fine tremor
(B) muscle atrophy
(D) pupillary constriction
(E) spontaneous remission
|33. A 47-year-old man presents to the emergency room with symptoms of dizziness and difficulty walking. He describes his dizziness as a spinning sensation of the room with associated nausea and vomiting. Which of the following findings suggests the vertigo is peripheral in origin?
(A) optic neuritis
(C) bidirectional nystagmus
(D) vertical nystagmus
(E) visual fixation does not affect vertigo or nystagmus
|36. A 67-year-old man develops coma over a few minutes. He is unresponsive on arrival to the hospital. He has ataxic respirations and pinpoint, reactive pupils. Oculocephalic reflexes are absent. There is no motor response with noxious stimulation. (SELECT ONE)
(A) basal ganglia hemorrhage
|37. A 74-year-old woman develops occipital headache, vomiting, and dizziness. She looks unwell, blood pressure 180/100 mm Hg, pulse 70/min, and respirations 30/min. She is unable to sit or walk because of unsteadiness. Over the next few hours, she develops a decline in her level of consciousness. (SELECT ONE)
(A) basal ganglia hemorrhage
|38. A 52-year-old man, with poorly controlled hypertension in the past, presents with increasing headache, confusion, and vomiting. His blood pressure is 230/125 mm Hg, pulse 60/min, respirations 24/min, and there is papilledema. He has no focal deficits. (SELECT ONE)
(A) basal ganglia hemorrhage
|39. A 24-year-old man has a history of recurrent throbbing headaches. He suddenly develops mild right-sided weakness. His blood pressure in the past has been normal but is now slightly elevated. (SELECT ONE)
|40. A 20-year-old man develops fatigue and severe muscle weakness of his limbs usually after eating a large meal. He is diagnosed with familial periodic paralysis. (SELECT ONE)
|43. A 27-year-old woman complains of double vision and fatigue at the end of the day. Further history reveals difficulty in chewing food, and some weakness in climbing stairs. She has stopped running because of easy leg fatigue and leg weakness. The symptoms improve with resting. On examination, there is weakness of the eyelids, masticatory muscles, and thigh flexors. Her handgrip decreases with repetitive action. There is no sensory abnormality, and reflexes are normal. Which of the following is the most likely diagnosis?
(B) myasthenia gravis
(C) multiple sclerosis
(D) thyroid storm
(E) meningeal lymphoma
|44. A 20-year-old man suffered a significant closed head injury after a diving accident. He is left with minor memory impairment but makes a full recovery. A few months later, he has a witnessed loss of consciousness with some arm and leg twitching. After the event, he is disoriented for 2 hours and then gradually returns to baseline. There was no incontinence or tongue biting, and his examination is normal. Which of the following is the most likely diagnosis?
(B) generalized seizure
(C) focal seizure
(D) cardiac arrhythmia
(E) drop attack