The Quizzes about Diseases of the Nervous System – Part 3 (29 test)

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The Quizzes about Diseases of the Nervous System – Part 3 (29 test)
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The-Quizzes-about-Diseases-of-the-Nervous-System

Select the ONE answer that is BEST in each case.

A 22-year-old woman presents with fever, headache, and confusion. She has not been herself for the past 2 days, including not going to work and forgetting events. On examination, she is moving all her limbs, but not oriented to place or time. The remaining examination is normal. A CT scan shows bilateral, small, lowdensity temporal lobe lesions. Cerebrospinal fluid (CSF) shows mononuclear cell pleocytosis, increased protein, and normal glucose. The electroencephalogram (EEG) shows bilateral periodic discharges from the temporal leads and slow-wave complexes at regular intervalsof 2–3/sec. Which of the following is the most appropriate treatment for her condition?

This patient has herpes simplex virus encephalitis. Acyclovir selectively inhibits viral deoxyribonucleic acid (DNA) polymerase. Acyclovir is currently the treatment of choice because of better efficacy and less toxicity than previous drugs. Because it is so nontoxic, therapy can be started even if the diagnosis is only presumptive.

 

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

Part 1Part 2 | Part 3 |

45. A 22-year-old woman presents with fever, headache, and confusion. She has not been herself for the past 2 days, including not going to work and forgetting events. On examination, she is moving all her limbs, but not oriented to place or time. The remaining examination is normal. A CT scan shows bilateral, small, lowdensity temporal lobe lesions. Cerebrospinal fluid (CSF) shows mononuclear cell pleocytosis, increased protein, and normal glucose. The electroencephalogram (EEG) shows bilateral periodic discharges from the temporal leads and slow-wave complexes at regular intervalsof 2–3/sec. Which of the following is the most appropriate treatment for her condition?
(A) penicillin
(B) chloramphenicol
(C) acyclovir
(D) erythromycin
(E) steroids
46. A 67-year-old woman with hypertension presents with sudden onset of headache, vomiting, and left-sided weakness. On examination, she has weakness of the left face, hand, and leg (graded three out of five), blood pressure of 180/100 mm Hg, and respiration of 20/min. Which of the following is the most appropriate initial diagnostic test?
(A) CT scan with contrast
(B) MR scan with gadolinium
(C) CT scan without contrast
(D) MR cerebral angiogram
(E) conventional cerebral angiogram
47. A 77-year-old woman develops acute hoarseness, difficulty swallowing, dizziness, and falling to the right side. On examination, there is  decreased sensation to pain on the right side of her face and left side of her body. The palate and pharynx move very little on the right side, and there is loss of coordination of the right arm and leg. Motor power in the arms and legs is normal. While attempting to walk, she falls to the right side, and complains of vertigo. An MRI scan confirms the diagnosis of the ischemic stroke. Which of the following is the most likely location of the stroke?
(A) right medial medulla
(B) right lateral medulla
(C) right internal capsule
(D) right parietal cortex
(E) right cerebellum
48. A 27-year-old woman, a recent immigrant from the Caribbean basin, has had progressive leg weakness. Physical examination revealsincreased tone of both legs with weakness, clonus, extensor plantar responses, and brisk reflexes. There is also loss of vibration and position senses in the feet. The upper extremities are normal. A clinical diagnosis of tropical spastic paraparesis (TSP) is made. Which of the following is the most likely cause of this condition?
(A) human immunodeficiency virus (HIV) infection
(B) cytomegalovirus (CMV) infection
(C) human T-cell lymphotropic virus (HTLV)-1 infection
(D) thiamine deficiency
(E) central nervous system (CNS) tuberculosis infection
49. A 40-year-old woman complains of episodes of severe unilateral, stabbing facial pain that is intermittent for several hours, and then disappears for several days. Physical examination is entirely normal. Which of the following is the most likely diagnosis?
(A) trigeminal neuralgia
(B) herpes zoster
(C) acoustic neuroma
(D) Bell’s palsy
(E) diabetic neuropathy
50. A 63-year-old man suddenly becomes acutely ill with headache and fever of 38.9°C. There is pain in the eye, and the orbits are painful to pressure. There is edema and chemosis of the conjunctivae and eyelids, and the eye bulbs are proptosed. Diplopia and ptosis are present, and the pupils are slow in reacting. Which of the following is the most likely diagnosis?
(A) cavernous sinus thrombosis
(B) chorioretinitis
(C) subarachnoid hemorrhage
(D) brain abscess
(E) none of the above
51. A 20-year-old woman presents with a history of rapid loss of vision in one eye. Examination reveals pain on movement of the eyeball. The appearance of the fundi is normal, but the afferent pupillary response is diminished. Perimetry shows a large central scotoma. Which of the following is the most likely diagnosis?
(A) optic atrophy
(B) papilledema
(C) retrobulbar neuritis
(D) amblyopia ex anopsia
(E) hysteria
52. A 67-year-old man has two episodes of numbness on the left side of his body, which last 5 minutes. He now experiences transient loss of vision in his right eye lasting 2 minutes. On examination, his blood pressure is 155/90 mm Hg, pulse 80/min regular, and visual fields, extraocular movements, and pupils are all normal. The remaining motor and sensory examination is also normal. Which of the following is the most likely diagnosis?
(A) posterior cerebral artery insufficiency
(B) parietal lobe neoplasm
(C) parasagittal meningioma
(D) AVM
(E) right internal carotid artery atherosclerosis
53. An 18-year-old man develops fever, headache, confusion, and generalized seizures. On examination, he is moving all his limbs, but incoherent. A CT scan shows bilateral, small, low-density temporal lobe lesions. CSF shows mononuclear cell pleocytosis, increased protein, and normal glucose. The EEG shows bilateral periodic discharges from the temporal leads and slowwave complexes at regular intervals of 2–3/sec. Which of the following is the most appropriate next step in management?
(A) angiography
(B) observing response to therapy(C) cerebral biopsy
(D) acute viral titers
(E) CSF culture
54. A 24-year-old woman presents with foot and leg weakness that is progressively getting worse over the past 1 week. Initially, she developed tingling in her feet and noticed that they would drag, but now she has difficulty standing and walking due to the leg weakness. Three weeks ago she had a “chest cold,” which resolved on its own. On examination, muscle bulk is normal, motor strength is two out of five in the quadriceps, and one out of five in the feet. Reflexes at the ankle and knee are absent, and sensation testing is normal. The upper limb examination is normal. The CSF protein is very high, glucose is normal, and cell count is slightly elevated. Which of the following is the most likely diagnosis?
(A) diabetic neuropathy
(B) alcoholic neuropathy
(C) Guillain-Barré syndrome
(D) cyanide poisoning
(E) poliomyelitis
55. A 37-year-old woman complains of drooping eyelids, double vision, and fatigue at the end of the day. Further history reveals difficulty in chewing food, and some weakness in climbing stairs. 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. Her chest x-ray (CXR) is shown in Fig. 7–2 a and b. Which of the following is the most likely diagnosis?
(A) bronchogenic carcinoma
(B) Hodgkin’s disease
(C) teratoma
(D) thyroid tumor with retrosternal extension
(E) thymoma
56. A 79-year-old woman is seen in the office for “dizziness.” Which of the following findings would suggest true vertigo?
(A) the patient is taking multiple antihypertensives
(B) the symptoms are worse on standing(C) she has had two falls
(D) the room is spinning around her
(E) a prior Holter monitor was negative during episodes of dizziness
57. A 65-year-old woman complains of recurrent episodes of sudden-onset dizziness and nausea. She notices an abrupt onset of a spinning sensation when rolling over or sitting up in bed. The symptoms last for 30 seconds and then completely resolve. She has no hearing change or other neurologic symptoms, and her physical examination is completely normal. A DixHallpike maneuver reproduces her symptoms. Which of the following findings on vestibular testing favors the diagnosis of benign paroxysmal positional vertigo (BPPV) over central positional vertigo?
(A) no latency period
(B) no fatigability
(C) habituation occurs
(D) mild vertigo
(E) symptoms consistently the same from one set of tests to the next
58. A 23-year-old man complains of intermittent double vision and fatigue at the end of the day. Further history reveals difficulty in chewing food, and some weakness in climbing stairs. He has stopped working as a courier because of easy leg fatigue and weakness. The symptoms improve with resting. On examination, there is weakness of the eyelids, masticatory muscles, and thigh flexors. Having him look up at the ceiling for a long period brings on his double vision. His handgrip decreases with repetitive action. There is no sensory abnormality, and reflexes are normal. Which of the following treatments is contraindicated in this patient?
(A) anticholinergic drugs
(B) surgery
(C) plasmapheresis
(D) cyclophosphamide
(E) high-dose prednisone
59. A 55-year-old man presents with increasing shortness of breath, decreased urine output, malaise, nausea, and vomiting. He has a history of hypertension, chronic renal failure, and coronary artery disease. His laboratory data reveal very high urea and creatinine, consistent with acute on chronic renal failure. He also notes having intermittent “twitching” in his arms and legs that started recently. (SELECT ONE)

(A) simple partial seizure
(B) complex partial seizures
(C) tonic-clonic (grand mal) seizures
(D) absence (petit mal) seizures
(E) myoclonic seizures
(F) status epilepticus

60. A 24-year-old woman complains of having intermittent bouts of smelling burning rubber followed by lip smacking and chewing movements as observed by others. During these spells, she does not respond to questions. There has never been any complete loss of consciousness during these episodes either. An MRI of the brain reveals temporal lobe sclerosis. (SELECT ONE)

(A) simple partial seizure
(B) complex partial seizures
(C) tonic-clonic (grand mal) seizures
(D) absence (petit mal) seizures
(E) myoclonic seizures
(F) status epilepticus

61. A teenager has a long history of “daydreaming” in school. EEG reveals evidence of a generalized seizure disorder, but there has never been a history of convulsive muscular activity. (SELECT ONE)

(A) simple partial seizure
(B) complex partial seizures
(C) tonic-clonic (grand mal) seizures
(D) absence (petit mal) seizures
(E) myoclonic seizures
(F) status epilepticus

62. A 23-year-old woman has a history of repetitive involuntary movements of her right hand associated with abnormal facial movements. At times, the movements spread to involve the entire arm. (SELECT ONE)

(A) simple partial seizure
(B) complex partial seizures
(C) tonic-clonic (grand mal) seizures
(D) absence (petit mal) seizures
(E) myoclonic seizures
(F) status epilepticus

63. This form of epilepsy almost always starts in childhood. (SELECT ONE)

(A) simple partial seizure
(B) complex partial seizures
(C) tonic-clonic (grand mal) seizures
(D) absence (petit mal) seizures
(E) myoclonic seizures
(F) status epilepticus

69. A 63-year-old man is noticed to have asymmetric pupils. He is completely well and has no symptoms. On examination, the left pupil is small, round, and has a brisk response to light and near stimuli (accommodation). There is also ptosis of the left eyelid, but no other ocular movement abnormality or symptoms of double vision. (SELECT ONE)

(A) essential anisocoria
(B) Horner syndrome
(C) tonic pupils (Holmes-Adie syndrome)
(D) Argyll Robertson pupils
(E) midbrain pupils
(F) atropinized pupils
(G) oculomotor palsy

70. A 23-year-old woman is noticed to have irregular pupils on routine examination. She has one large pupil, which has minimal response to light stimulation, but it does respond to accommodation. The eye movements are normal and she experiences no double vision. (SELECT ONE)

(A) essential anisocoria
(B) Horner syndrome
(C) tonic pupils (Holmes-Adie syndrome)
(D) Argyll Robertson pupils
(E) midbrain pupils
(F) atropinized pupils
(G) oculomotor palsy

71. A 57-year-old woman presents for evaluation of memory loss. She is noticed to have small, irregular pupils that respond poorly to light but pupillary response to accommodation is normal. (SELECT ONE)

(A) essential anisocoria
(B) Horner syndrome
(C) tonic pupils (Holmes-Adie syndrome)
(D) Argyll Robertson pupils
(E) midbrain pupils
(F) atropinized pupils
(G) oculomotor palsy

72. A 24-year-old man notices different size pupils. The left pupil is 1 mm larger than the right. Both pupils respond normally to light and accommodation. The discrepancy in the pupils is still there in low, medium, and bright light conditions. He reports no other visual symptoms. (SELECT ONE)

(A) essential anisocoria
(B) Horner syndrome
(C) tonic pupils (Holmes-Adie syndrome)
(D) Argyll Robertson pupils
(E) midbrain pupils
(F) atropinized pupils
(G) oculomotor palsy

73. A 64-year-old woman is having double vision and severe headaches. On examination, the left pupil is dilated compared to the right, and the light response is diminished. (SELECT ONE)

(A) essential anisocoria
(B) Horner syndrome
(C) tonic pupils (Holmes-Adie syndrome)
(D) Argyll Robertson pupils
(E) midbrain pupils
(F) atropinized pupils
(G) oculomotor palsy

74. A 48-year-old man complains of muscle weakness in his right hand (dominant hand). On examination, the hand muscles are smaller than on the left, and the reflexes are decreased out of proportion to weakness. (SELECT ONE)

(A) anterior horn cell
(B) peripheral nerve
(C) neuromuscular junction
(D) muscle

75. A 26-year-old woman complains of early fatigue and weakness in doing strenuous activity. Her symptoms are worse near the end of the day. She appears well, muscle bulk, tone, and reflexes are normal. Handgrip strength decreases with repetitive testing. (SELECT ONE)

(A) anterior horn cell
(B) peripheral nerve
(C) neuromuscular junction
(D) muscle

76. A 63-year-old woman has noticed weakness in her right hand such that she is having difficulty writing and doing up buttons. On examination, there is marked atrophy of the forearm and hand muscles with fasciculations. Tone is increased and reflexes are brisk. Sensory testing in the hand is normal. There are also fasciculations on her thighs, which she has never noticed before. (SELECT ONE)

(A) anterior horn cell
(B) peripheral nerve
(C) neuromuscular junction
(D) muscle

77. A 49-year-old man notices weakness and numbness in his left hand. He had recently slipped on a wet floor and injured his elbow. Examination of the hand reveals predominantly weakness to abduction and adduction and sensory loss over the fourth and fifth fingers. (SELECT ONE)

(A) anterior horn cell
(B) peripheral nerve
(C) neuromuscular junction
(D) muscle

78. A 67-year-old man with lung cancer notices symptoms of weakness in his arms and legs. He describes difficulty in rising out of chair or going upstairs, but no pain or discomfort. On examination, proximal muscle strength is four out of five in the upper and lower limbs, but the reflexes, tone, and sensation are normal. He has a colored rash on his eyelids, and raised papules on his knuckles. (SELECT ONE)

(A) anterior horn cell
(B) peripheral nerve
(C) neuromuscular junction
(D) muscle

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