Block 13 Pace 1 Prt 1
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Questions and Answers
- 1.
An 18-year-old woman presents to the University’s clinic with a behavioral problem. She must get up at 5 a.m. in the morning to get to her first class in time. However, the time needed is expanding and she is now missing her class. She must go through a ritual of dressing, packing her books and going through doors and down steps that is taking more and more time. She has always had to be meticulous to get things done right, but she is now facing the fact that she cannot control it. Besides CBT, what is the best pharmacotherapy a physician might prescribe for this condition?
- A.
Sertraline
- B.
Alprazolam
- C.
Amphetamine
- D.
Clozapine
- E.
Selegeline
Correct Answer
A. SertralineExplanation
A) * SSRI’s first line treatment and best treatment for Anxiety Disorders, in this case its OCD
B) Alprazolam is not the best choice for an Anxiety Disorder
C) This is used for ADD
D) an atypical antipsychotic for treatment of schizophrenia
E) a drug used in PD or at higher doses in major depression as 2nd line.Rate this question:
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- 2.
2) A 32-year-old man presents to his family physician with complaints about headaches. He says either a headache or a stomachache seems to interfere with his work and his boss is complaining. Upon questioning, he admits that he now finds his work is stressful but hadn’t a year ago, has lost weight over the past 6 months, sleeps all the time on the weekends, finds it hard to get up during the week, and is bored with life. His physician rules out physical ailments with several tests and suggests a diagnosis. He recommends they try pharmacotherapy that will work to increase the action of several monoamines and that they may in turn reverse stress induced damage. What is a first line drug for his condition? (Options F & G only for discussion)
- A.
Clomipramine
- B.
Clonazepam
- C.
Chordiazepoxide
- D.
Varenicline
- E.
Venlafaxine
- F.
Sertraline
- G.
Selegiline
Correct Answer
E. VenlafaxineExplanation
The patient's symptoms, such as weight loss, excessive sleep, difficulty waking up, and loss of interest in life, suggest a possible diagnosis of depression. Venlafaxine is a first-line drug for depression as it works to increase the action of several monoamines, such as serotonin and norepinephrine, which are known to be involved in mood regulation. By increasing the levels of these neurotransmitters, venlafaxine can help alleviate the symptoms of depression and potentially reverse stress-induced damage.Rate this question:
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- 3.
A 19-year-old girl and her fiancé come to see her doctor to discuss her present antiepileptic drug therapy. They are to be married soon, and want to start a family. Her doctor discusses her present diagnosis of complex partial and secondarily generalized tonic-clonic seizures, from which she has suffered over the past three years. She was first treated with Drug A, which gave her severe gingival hyperplasia, acne, and mental dullness; therefore, this drug was stopped. Drug A was followed by Drug B, which caused her to gain weight, lose hair, and develop a tremor; Drug B was also was stopped. When she started on Drug X, its plasma levels seemed to decrease very quickly and the dose had to be adjusted upwards. Drug X effectively controls her condition, and the doctor says that it is safer than some of the others in pregnancy. Which of the options below correctly identifies drug X?
- A.
Drug X is phenytoin
- B.
Drug X is valproate
- C.
Drug X is carbamazepine
- D.
Drug X is ethosuximide
- E.
Drug X is diazepam
Correct Answer
C. Drug X is carbamazepineExplanation
The correct answer is Drug X is carbamazepine. The patient's symptoms of complex partial and secondarily generalized tonic-clonic seizures suggest epilepsy. The side effects experienced with Drug A (gingival hyperplasia, acne, mental dullness) and Drug B (weight gain, hair loss, tremor) are consistent with phenytoin and valproate, respectively. Since Drug X effectively controls her condition and is safer in pregnancy, it is likely to be carbamazepine, which is commonly used to treat epilepsy and has a lower risk of teratogenicity compared to other antiepileptic drugs.Rate this question:
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- 4.
A 25-year-old woman presented at the emergency room with tremors, hyper-reflexia, tachycardia, mydriasis, increased bowel sounds, gait difficulties and delirium. She has a history of depression, anxiety and opiate dependence. She is currently being treated with fluoxetine, olanzepine and methadone. What best explains the symptoms she has presented with?
- A.
Benzodiazepine overdose
- B.
Alcohol overdose
- C.
GABA syndrome
- D.
Serotonin syndrome
- E.
Opiate overdose
Correct Answer
D. Serotonin syndromeExplanation
The symptoms described in the case, including tremors, hyper-reflexia, tachycardia, mydriasis, increased bowel sounds, gait difficulties, and delirium, are consistent with serotonin syndrome. Serotonin syndrome is a potentially life-threatening condition caused by an excess of serotonin in the central nervous system. It can occur when multiple medications that increase serotonin levels, such as fluoxetine and olanzepine, are taken together. The patient's history of depression, anxiety, and opiate dependence, as well as the current treatment with fluoxetine, olanzepine, and methadone, support the diagnosis of serotonin syndrome.Rate this question:
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- 5.
A 20-year-old woman was brought to the emergency room presenting with bizarre behaviors. She was speaking very fast and she was talking about voices she heard. She had run out into the street because she thought aliens were chasing her. She was given a drug that helped block the voices and fear she was experiencing. What was the most likely identity of this drug?
- A.
Clozapine
- B.
Aripiprazole
- C.
Asenapine
- D.
Haloperidol
- E.
Valproate
Correct Answer
D. HaloperidolExplanation
Haloperidol is the most likely identity of the drug given to the woman. Haloperidol is an antipsychotic medication commonly used to treat symptoms of psychosis, such as hallucinations and delusions. The woman's bizarre behaviors, fast speech, and belief that aliens were chasing her suggest a psychotic episode. Haloperidol helps block the voices and fear she was experiencing, indicating its effectiveness in treating psychosis.Rate this question:
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- 6.
Your 24-year-old, single, white, male, American patient presents with the following chief complaint: “I’ve been having terrible headaches for the past 6 weeks.” Upon inquiring further about the patient’s headaches and his thoughts regarding the possible cause, he responds by informing you of the following: “An evil spirit who lives in the tree in my backyard is extracting thoughts from my head and it hurts.” The type of psychiatric symptom exhibited by your patient is best described as a(n):
- A.
Hallucination
- B.
Delusion
- C.
Illusion
- D.
Parapraxis
- E.
Bizarre Delusion
Correct Answer
E. Bizarre DelusionExplanation
The patient's belief that an evil spirit is extracting thoughts from his head is an example of a delusion. Delusions are false beliefs that are firmly held despite evidence to the contrary. In this case, the belief is bizarre because it involves a supernatural entity and is not based in reality. This type of delusion is often seen in psychotic disorders such as schizophrenia.Rate this question:
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- 7.
The patient cannot remember what their boss said after he told the boss that he had lost the ongoing contract for 100 million dollars of service. This will cripple the company and cause massive layoffs at best. This memory failure is best understood as:
- A.
A further symptom of CNS lesions or damage
- B.
A dissociative process, often used as a defense mechanism
- C.
Only caused by alcohol ingestion
- D.
A predictable side effect of sleep medication
- E.
A sign of a weak superego
Correct Answer
B. A dissociative process, often used as a defense mechanismExplanation
The patient's inability to remember what their boss said after delivering such devastating news suggests a dissociative process. Dissociation is a defense mechanism that helps individuals detach from overwhelming or traumatic experiences. In this case, the patient's mind may be protecting them from the emotional distress associated with the potential consequences of losing the contract. This memory failure is not likely caused by CNS lesions or damage, alcohol ingestion, sleep medication, or a weak superego.Rate this question:
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- 8.
A 48-year-old woman, who had a cadaveric renal transplant 2 months ago, presented at the emergency department complaining of a fever, stiff neck, and progressively worsening headache. A lumbar puncture was performed and an elevated opening pressure was noted. CSF analysis revealed a leukocytic pleocytosis (89% PMNs) with a glucose level of 30 mg/dL (nl 40-70) and a protein level of 320 mg/dL (nl <40). All of the CSF antigen tests were negative. A Gram stain of the CSF is shown below. How was this infection most likely acquired?
- A.
Inhalation of droplet nuclei
- B.
Using a family member’s toothbrush
- C.
Sharing contaminated needles
- D.
Eating contaminated dairy products
- E.
Inoculation through a cut on the skin
Correct Answer
D. Eating contaminated dairy products -
- 9.
A 29-year-old female graduate student was transported to the emergency department in coma. Her roommate reports that the woman had felt unwell for the past 48 hours while complaining of headache and fever. Salient clinical features on admission include a Glasgow Coma Scale score of 8, positive Kernig and Brudzinski signs resulting in flexion/withdrawl of the left upper extremity greater than the right upper extremity, a temperature of 102 F, and blurred optic disc margins. The rest of her vital signs were normal except for a tachycardia. What investigation should be performed first?
- A.
Cold caloric testing
- B.
Cranial imaging
- C.
Lumbar puncture with CSF examination
- D.
Cerebral angiography
- E.
Skull and cervical spine x-rays
Correct Answer
B. Cranial imagingExplanation
The patient presents with symptoms of headache, fever, altered mental status, and signs of meningeal irritation (positive Kernig and Brudzinski signs). These findings suggest a possible diagnosis of meningitis, which is an inflammation of the meninges. Cranial imaging, such as a CT scan or MRI, should be performed first to evaluate for any intracranial abnormalities, such as brain abscess or mass effect, that may be causing the patient's symptoms. This will help guide further management and treatment decisions. Lumbar puncture with CSF examination would be the next step to confirm the diagnosis and determine the causative organism.Rate this question:
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- 10.
A 34-year-old man was admitted to the hospital for reduction of a dislocated shoulder. Sedation with diazepam was supplemented with administration of 30% concentration of nitrous oxide. Which of the following effects most likely occurred after nitrous oxide administration?
- A.
General muscle relaxation was excellent.
- B.
Unconsciousness was achieved rapidly.
- C.
Analgesia was very pronounced
- D.
Blood pressure was sharply decreased
- E.
Respiration was profoundly depressed
Correct Answer
C. Analgesia was very pronouncedExplanation
After the administration of nitrous oxide, the most likely effect that occurred was a pronounced analgesia. Nitrous oxide is commonly used as an analgesic and anesthetic agent in medical procedures. It has potent analgesic properties, providing pain relief to the patient. This effect is particularly useful in reducing the discomfort associated with reduction of a dislocated shoulder. Other effects mentioned in the options, such as general muscle relaxation, unconsciousness, decreased blood pressure, and depressed respiration, are not typically associated with nitrous oxide administration.Rate this question:
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- 11.
A 45 yo male presents with an acute headache grade 3/10 and then develops sudden left hemiparesis, face and arm> leg. He speaks of mild nausea and one short episode of vomiting food from his recent meal and loses consciousness. What do you expect the diagnosis after you complete the history, PE and work up most likely to be?
- A.
Migraine headache
- B.
Seizure with secondary generalization
- C.
Aneurysmal bleed
- D.
Internal capsule stroke
- E.
Intracerebral hemorrhage
Correct Answer
E. Intracerebral hemorrhageExplanation
Based on the given information, the most likely diagnosis would be intracerebral hemorrhage. The sudden onset of left hemiparesis, along with the acute headache and loss of consciousness, suggests a bleeding within the brain. The symptoms of nausea, vomiting, and the specific pattern of weakness (face and arm greater than leg) further support this diagnosis. Other options such as migraine headache, seizure with secondary generalization, aneurysmal bleed, and internal capsule stroke do not fit as well with the given symptoms.Rate this question:
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- 12.
A 22 yo male develops a sudden onset of a generalized seizure and post-ictally has a dense left hemiplegia. He speaks of headache and on examination has hyperreflexia and a Babinski left. There is a family history of SAH. You make a differential diagnosis. How would you best manage this patient?
- A.
Treat with tPA after a workup
- B.
Treat with anticonvulsants after a work up
- C.
Work up to r/o epilepsy
- D.
Start aspirin and proceed with a workup.
- E.
None of the above
Correct Answer
B. Treat with anticonvulsants after a work upExplanation
Based on the patient's presentation of sudden onset seizure, post-ictal left hemiplegia, headache, hyperreflexia, Babinski sign, and family history of SAH, the most likely diagnosis is a hemorrhagic stroke. Therefore, the best management for this patient would be to treat with anticonvulsants after a workup. This approach would involve conducting further investigations, such as imaging studies (e.g., CT or MRI), to confirm the diagnosis and identify the underlying cause of the hemorrhage. Once the workup is completed, anticonvulsants can be initiated to prevent further seizures.Rate this question:
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- 13.
A 55 year old patient is seen in the ER having been found wandering around apparently lost in a shopping mall. His wife says that this problem has not happened before, although her husband has been having episodes where his memory fails. He seems well for a while then another episode happens. He never seems to recover completely and his condition is gradually worsening in almost a stepwise fashion. General neurological exam is normal. The most likely diagnosis is:
- A.
Vascular dementia
- B.
Frontotemporal dementia
- C.
Alcoholism
- D.
Alzheimer’s
- E.
PCA (posterior cerebral artery) stroke
Correct Answer
A. Vascular dementiaExplanation
Based on the given information, the most likely diagnosis is vascular dementia. The patient's symptoms of memory failure, gradual worsening of condition, and stepwise fashion suggest a vascular etiology. Additionally, the absence of any abnormalities in the general neurological exam supports this diagnosis. Vascular dementia is caused by reduced blood flow to the brain, leading to cognitive decline. The other options, such as frontotemporal dementia, alcoholism, Alzheimer's, and PCA stroke, do not fit the clinical presentation described in the question.Rate this question:
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- 14.
Joan is 45 years old. She is brought to Emergency having passed out in the street. She was witnessed having jerky movements and was incontinent. It is now 45 minutes since this happened and Joan has had another two episodes on the way to hospital and yet another as she arrives. Her best pharmacological management would MOST LIKELY BE INITIATED by:
- A.
Oxygen and gentle restraint
- B.
IV thiamine diazepam
- C.
Observation only
- D.
Oral diazepam
- E.
Valproic acid IM
- F.
Oral ethosuximide
Correct Answer
B. IV thiamine diazepamExplanation
The correct answer is IV thiamine diazepam. This is because Joan's symptoms, including passing out, jerky movements, and incontinence, suggest that she may be experiencing seizures. IV thiamine is given to treat or prevent Wernicke's encephalopathy, which can be caused by alcohol abuse and can lead to seizures. Diazepam is a medication that can be used to treat seizures. Administering thiamine and diazepam intravenously would be the most appropriate pharmacological management in this case.Rate this question:
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- 15.
A 62-year-old male presents with headache, vomiting and weakness of his left side. Physical examination reveals his right eye to be pointing “down and out” and ptosis of his right eyelid. His right pupil is fixed and dilated unresponsive to accommodation. There is also marked weakness in his left arm and leg. There is papilledema on examination of the retina. These manifestations are most likely associated with which of the following?
- A.
Aneurysm of the vertebrobasilar artery
- B.
Arteriovenous malformation of the anterior cerebral artery
- C.
Subfalcine herniation
- D.
Tonsillar herniation
- E.
Uncal herniation
Correct Answer
E. Uncal herniationExplanation
The patient's symptoms, including headache, vomiting, weakness of the left side, "down and out" eye, ptosis of the right eyelid, fixed and dilated pupil, and papilledema, are consistent with uncal herniation. Uncal herniation occurs when there is a mass effect in the brain, leading to displacement of the uncus of the temporal lobe. This can cause compression of the oculomotor nerve, resulting in the characteristic eye findings. Additionally, the weakness in the left arm and leg suggests involvement of the contralateral cerebral hemisphere, further supporting the diagnosis of uncal herniation.Rate this question:
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- 16.
A 28-year-old woman began to stumble when walking. Her right leg was slightly stiff and weak, especially after exercise and hot showers. These symptoms developed over 3 days and gradually disappeared over 4 weeks. One year later, 10 days after a “cold,” she developed blurred vision in her right eye and her visual acuity dropped to 20/200. She had moderate pain behind her eye when she looked to either side. Two years later, she noticed that both legs were becoming gradually weaker and spastic and she needed to run to the bathroom nearly every hour to urinate. These symptoms slowly progressed over the next 10 years, with occasional exacerbations affecting other areas of the brain. Which of the following brain structures are the most common sites for formation of lesions in this patient?
- A.
Paraventricular white matter, optic nerve, brainstem, and grey matter of the spinal cord
- B.
Paraventricular grey matter, brainstem, and grey matter of the spinal cord
- C.
Cerebral white matter, optic nerve- chiasm, brainstem, and white matter of the spinal cord
- D.
Basal ganglia, optic nerve, brain stem, and white matter of the spinal cord
Correct Answer
C. Cerebral white matter, optic nerve- chiasm, brainstem, and white matter of the spinal cordExplanation
The patient's symptoms are consistent with a diagnosis of Multiple Sclerosis (MS). MS is an autoimmune disease characterized by the formation of lesions in the central nervous system. The lesions can occur in various areas of the brain and spinal cord. In this case, the most common sites for lesion formation are the cerebral white matter, optic nerve-chiasm, brainstem, and white matter of the spinal cord. These areas are commonly affected in MS and can explain the patient's symptoms of visual impairment, weakness, spasticity, urinary frequency, and occasional exacerbations affecting other areas of the brain.Rate this question:
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- 17.
A 72-year-old woman presented for evaluation of "short-term memory loss" at the behest of her family. The patient acknowledged memory difficulty but no more than her age-peers. History was, therefore, obtained from her daughter. Difficulties in cognition and daily function were first noted about 3 years earlier, shortly after she was widowed. More recently, she had discontinued her regular church attendance, had been noted to wear dirty clothing. On cognitive examination, she was not oriented to date or month, but could identify the day of the week. She could repeat 3 words, but recalled none after 5 minutes of distraction. She correctly named the president, but not the governor. She could not recount any recent major news events. She could name a watch, pencil, and jacket, but could not name the lapel, sleeve, or cuff. She correctly drew a clock, but could not set the hands to 8:20. General neurologic examination was unrevealing, apart from diminished large fiber sensation in the distal lower extremities, and a mildly unsteady gait. Which of the following pathologic changes are characteristic for her disease?
- A.
Cortical atrophy, neurofibrillary tangles, and neuritic plaques
- B.
Lewy bodies, neurofibrillary tangles, and neuritic plaques
- C.
Neurofibrillary tangles, neuritic plaques, and watershed liquefactive necrosis
- D.
Amyloid angiopathy, loss of neurons in the caudate and hippocampus, and senile plaques
Correct Answer
A. Cortical atropHy, neurofibrillary tangles, and neuritic plaquesExplanation
The patient's presentation of memory difficulty, difficulties in cognition and daily function, and the inability to recall recent major news events suggest a neurodegenerative disease. The presence of cortical atrophy, neurofibrillary tangles, and neuritic plaques is characteristic of Alzheimer's disease, the most common cause of dementia in older adults. Cortical atrophy refers to the shrinking of the cerebral cortex, which is seen in Alzheimer's disease. Neurofibrillary tangles are twisted protein fibers that accumulate inside nerve cells, and neuritic plaques are abnormal clusters of proteins that form between nerve cells. These pathological changes are consistent with the diagnosis of Alzheimer's disease in this patient.Rate this question:
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- 18.
A 43-year-old white male complains to his family physician of increasingly severe headaches upon awakening of a few months' duration; the headaches persist throughout the afternoon and are mild in the evenings. While in the doctor's office, the patient suffers a seizure and is brought to the emergency room. Fundoscopy reveals papilledema. A CT scan ordered has a large frontal lobe mass with focal nodular calcifications. Which of the following criteria are used for the surgical pathology diagnosis of the lesion present in this patient?
- A.
Pleomorphic glial cells, high mitotic activity, pseudopalisading, + vascular proliferation
- B.
Cyst with mural nodule, pilocytic astrocytes with Rosenthal fibers
- C.
Well circumscribed nodule, whorls of spindle-shaped cells, and psammoma bodies
- D.
Bipolar elongated cells, long fibrils “hairy cells” and Rosenthal fibers
- E.
Well circumscribed nodule, “fried-egg” cells, and chicken-wire capillary pattern
Correct Answer
E. Well circumscribed nodule, “fried-egg” cells, and chicken-wire capillary patternExplanation
The correct answer for the surgical pathology diagnosis of the lesion present in this patient is "Well circumscribed nodule, 'fried-egg' cells, and chicken-wire capillary pattern." This is suggestive of a meningioma, which is a common benign tumor of the meninges. Meningiomas are typically well circumscribed and have characteristic histological features, including "fried-egg" cells (cells with abundant eosinophilic cytoplasm and round nuclei) and a chicken-wire capillary pattern (dense network of thin-walled capillaries). Other options listed in the question stem are characteristic of different types of brain tumors and do not fit with the clinical presentation and imaging findings described.Rate this question:
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- 19.
A 56-year-old diabetic female was in her usual state of health until 6 weeks prior to admission, when she had a 3-week episode of apparent “flu” characterized by fatigue, aching joints, nausea, vomiting, and headache. She recovered briefly, but then had recurrence of headaches. Two weeks prior to admission the patient became confused and was hospitalized. On admission she was found to be febrile to 104.6°F and significantly dehydrated. Hematocrit was normal. White blood count was 15,000, with 94% polymorphonuclear leukocytes. Blood sugar was 230 mg/dl, but ketones were absent. Head MRI showed in excess of 10 ring-enhancing and solid lesions scattered throughout both cerebral hemispheres, with surrounding edema. Production of connective tissue and collagen accumulation in this patient are characteristically associated with one of the following:
- A.
Chronic brain abscess
- B.
Creutzfeldt-Jacob disease
- C.
Multiple sclerosis
- D.
Alzheimer disease
- E.
Amyotrophic Lateral Sclerosis
Correct Answer
A. Chronic brain abscessExplanation
The presence of ring-enhancing and solid lesions scattered throughout both cerebral hemispheres, along with surrounding edema, on the head MRI suggests the presence of a chronic brain abscess. Chronic brain abscesses are typically caused by bacterial or fungal infections, and they can lead to the production of connective tissue and collagen accumulation. This is consistent with the patient's symptoms of fever, confusion, and dehydration, as well as the elevated white blood count with a high percentage of polymorphonuclear leukocytes. The absence of ketones in the blood and the normal hematocrit also support the diagnosis of a chronic brain abscess rather than other conditions such as Creutzfeldt-Jacob disease, multiple sclerosis, Alzheimer's disease, or amyotrophic lateral sclerosis.Rate this question:
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- 20.
A 58-year-old female was admitted because had been disoriented with respect to time, she was also noted to be severely depressed, with crying spells. Her speech was slow and dysarthric with an irregular rhythm and explosive quality. Repetition, naming, and comprehension were impaired. She could read words, but apparently without understanding, and she was unable to write. She showed apraxia for motor and eye movements and demonstrated perseveration, right-left confusion, and difficulty with calculations. Her fund of knowledge was markedly reduced. Cranial nerve abnormalities were limited to a decrease in the range of upward gaze and a flattening of the left nasolabial field. The limbs were bilaterally spastic with generally hyperactive tendon reflexes, especially on the left. A jaw jerk was prominent and the left plantar response was extensor. The right hand was maintained in a position of dystonic hyperextension with trapping of the thumb. There was an ataxic tremor in the arms and legs. Gait was wide based and unsteady. Occasional irregular jerking of the right arm and leg was present at rest and increased during attempts at voluntary movement. During the next 2 weeks, she deteriorated rapidly, becoming incontinent with progressively increasing spasticity and more frequent jerks. Speech continued to worsen until it ceased altogether. The neuropathologic findings were typical of Creutzfeldt-Jakob disease. A diagnosis of possible familial Creutzfeldt-Jakob disease was raised although no genetic testing was available for further investigations. Which of the following biochemical processes underlies the demonstrated pathology?
- A.
Accumulation of paired helical filaments in the neurophil
- B.
Extracellular accumulation of Aβ-amyloid
- C.
Accumulation of β-pleated prion proteins in the neurophil
- D.
Intracellular accumulation of α-helical prion proteins
- E.
Intracellular accumulation of a protein with polyglutamine repeat expansion
Correct Answer
C. Accumulation of β-pleated prion proteins in the neuropHilExplanation
The correct answer is "Accumulation of β-pleated prion proteins in the neurophil." This is the underlying biochemical process in Creutzfeldt-Jakob disease. The patient's symptoms, such as cognitive impairment, dysarthria, apraxia, and spasticity, are consistent with the neurodegenerative effects of prion protein accumulation in the brain. The neuropathologic findings also support this, confirming the presence of typical changes seen in Creutzfeldt-Jakob disease.Rate this question:
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- 21.
A 32-year-old white female, who migrated to the US form Finland 10 years ago, presents with loss of vision in her left eye with eye pain and impairment of color vision; the symptoms started two weeks prior to attending to the clinic and then gradually progressed. Fundoscopy reveals a swollen optic disk in the left eye. Which of the following are the most likely concomitant brain changes that can be identified by MRI?
- A.
Foci of demyelination in the paraventricular white matter
- B.
Tumor affecting the white matter of both cerebral hemispheres
- C.
Accumulation of thick exudate at the base of the brain
- D.
Diffuse rarefaction of the subcortical white matter
- E.
Hemorrhages in the right temporal lobes
Correct Answer
A. Foci of demyelination in the paraventricular white matterExplanation
The patient's symptoms of loss of vision, eye pain, and impairment of color vision, along with a swollen optic disk, are suggestive of optic neuritis. Optic neuritis is commonly associated with multiple sclerosis (MS), which is characterized by the demyelination of nerve fibers. The most likely concomitant brain changes that can be identified by MRI in this case are foci of demyelination in the paraventricular white matter, which is a characteristic finding in MS.Rate this question:
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- 22.
A 46-year-old male AIDS patient died of pontine infarct. Microscopic report of the autopsy study was arteritis of the basilar artery along with abundant monomorphic, septate, filamentous organisms with dichotomous branching enhanced with silver methenamine stain. What is the most likely diagnosis?
- A.
Candidiasis
- B.
Mucormycosis
- C.
Blastomycosis
- D.
Aspergillosis
- E.
Actinomycosis
Correct Answer
D. AspergillosisExplanation
The most likely diagnosis in this case is Aspergillosis. The autopsy study revealed arteritis of the basilar artery along with abundant monomorphic, septate, filamentous organisms with dichotomous branching, which is characteristic of Aspergillus species. Aspergillosis is a fungal infection caused by the Aspergillus fungus, and it commonly affects immunocompromised individuals such as AIDS patients. The presence of the fungal organisms in the basilar artery suggests that the infection spread through the bloodstream, leading to the pontine infarct and ultimately the patient's death.Rate this question:
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- 23.
A 24-year-old woman who wants to become pregnant has had no menses since she discontinued the use of an oral contraceptive one year ago, and recently, galactorrhea developed. She takes no medications and has had no headaches, visual loss, dyspareunia, or decreased libido. Physical examination shows no abnormalities except for bilateral breast discharge. A test of serum human chorionic gonadotropin is negative, and the serum LH and estradiol levels are below normal. Which one of the following is the most likely cause of these signs and symptoms?
- A.
Prolactinoma of the pituitary gland
- B.
Germinoma of the pineal gland.
- C.
Medullary carcinoma of the thyroid gland
- D.
Craniopharyngioma of the hypotalamus
- E.
Islet cell adenoma of the pancreas
Correct Answer
A. Prolactinoma of the pituitary glandExplanation
The most likely cause of the woman's signs and symptoms is a prolactinoma of the pituitary gland. This is suggested by the presence of galactorrhea (abnormal breast discharge) and the low levels of LH and estradiol. Prolactinomas are benign tumors of the pituitary gland that secrete excessive amounts of prolactin, leading to menstrual irregularities and galactorrhea. The negative test for human chorionic gonadotropin rules out pregnancy as the cause. The other options (germinoma of the pineal gland, medullary carcinoma of the thyroid gland, craniopharyngioma of the hypothalamus, and islet cell adenoma of the pancreas) are not associated with the specific signs and symptoms described.Rate this question:
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