Block 13 Pace 1 Prt 2
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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
Correct Answer
B. Pilocytic astrocytomaExplanation
The most likely diagnosis in this case is pilocytic astrocytoma. This is suggested by the presentation of the patient with headaches, nausea, and vomiting, as well as the findings on the MRI scan which show hydrocephalus and a posterior fossa mass. Pilocytic astrocytoma is a type of brain tumor that commonly occurs in children and is often located in the posterior fossa. The gross and microscopic appearance of the lesion shown in the question is consistent with pilocytic astrocytoma.Rate this question:
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- 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
Correct Answer
C. Guillain-Barre syndromeExplanation
The most likely diagnosis in this case is Guillain-Barre syndrome. This is supported by the acute onset of ascending paralysis following a respiratory tract infection, which is a characteristic feature of Guillain-Barre syndrome. The marked slowing of nerve conduction velocity studies also aligns with this diagnosis. Additionally, the patient's eventual complete recovery of respiratory and motor functioning after receiving respiratory support, corticosteroids, and plasmaphoresis is consistent with the typical course of Guillain-Barre syndrome.Rate this question:
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- 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
Correct Answer
C. Rupture of berry aneurysmExplanation
The most likely cause of the patient's neurological abnormality is the rupture of a berry aneurysm. This is indicated by the sudden onset of a severe headache followed by coma and death, which are consistent with subarachnoid hemorrhage. Berry aneurysms are the most common cause of subarachnoid hemorrhage, and they typically occur in individuals with a history of systemic hypertension. The other options, such as Charcot-Bouchard aneurysm, anthrax, mycotic aneurysm, and Kaposi sarcoma metastasizing to the subarachnoid space, are less likely based on the given information.Rate this question:
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- 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
Correct Answer
B. Relentless progression to death, usually from secondary infectionExplanation
The correct answer is "relentless progression to death, usually from secondary infection." In severe hemophilia A, the development of symptoms of widespread cerebral inflammation suggests the presence of a severe complication called intracranial hemorrhage. The microglial nodules and abnormal cells seen on biopsy indicate an inflammatory response in the brain. Without treatment, the intracranial hemorrhage and cerebral inflammation will continue to progress, leading to worsening neurological symptoms and ultimately death, often due to secondary infection.Rate this question:
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- 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
Correct Answer
A. Foci of demyelinationExplanation
The most likely pathologic finding in this patient's brain is foci of demyelination. This is suggested by the relapsing and remitting episodes of neurologic deficits, gradual and partial remissions, mildly elevated protein level in the spinal fluid, and increased gamma globulin with oligoclonal banding. These findings are consistent with multiple sclerosis, which is characterized by the immune system attacking the myelin sheath in the central nervous system, leading to foci of demyelination.Rate this question:
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- 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
Correct Answer
A. Bite of an infected mosquitoExplanation
The mode of transmission of the causative agent, West Nile virus, is through the bite of an infected mosquito.Rate this question:
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- 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
Correct Answer
C. Streptococcus pneumoniaeExplanation
The patient's presentation is consistent with bacterial meningitis, as evidenced by the fever, headache, stiff neck, mild confusion, positive Kernig and Brudzinski signs, and abnormal CSF findings. The most common causative agent of bacterial meningitis in adults is Streptococcus pneumoniae, which is also known as pneumococcus. This bacterium commonly colonizes the nasopharynx and can cause invasive infections, such as meningitis, when it gains access to the bloodstream. The CSF findings of a leukocytic pleocytosis with predominantly neutrophils, low glucose, and elevated protein are typical of bacterial meningitis, and Streptococcus pneumoniae is the most common cause of this type of meningitis in adults.Rate this question:
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- 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
Correct Answer
D. History of focusing problems when he was six years oldExplanation
The basis for the physician's presumptive diagnosis is the patient's history of focusing problems when he was six years old. This suggests that the patient has had long-standing difficulties with attention and concentration, which is consistent with a diagnosis of Attention Deficit Hyperactive Disorder, Inattentive type. The other options, such as history of poor concentration, history of easy distractibility, poor performance on the verbal component of the MCAT, and history of poor attention in class, are also indicative of attention difficulties but do not provide as strong of a basis for the diagnosis as the patient's history of focusing problems at a young age.Rate this question:
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- 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
Correct Answer
E. Acute Stress ReactionExplanation
Based on the reported symptoms, the best DSM IV classification at this time would be Acute Stress Reaction. The patient is experiencing intense fear and avoidance behaviors following a recent strong earthquake, which is a traumatic event. She also describes feeling emotionally numb and detached from herself, which are common symptoms of acute stress reaction. Additionally, her symptoms have been present for the last two weeks and have not improved or worsened during that time, which is consistent with the time frame for acute stress reaction.Rate this question:
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- 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
Correct Answer
D. Post Traumatic Stress DisorderExplanation
The patient's symptoms of chronic worrying, re-experiencing traumatic events, overreacting to loud noises, and trouble focusing in traffic situations are consistent with Post Traumatic Stress Disorder (PTSD). PTSD is a mental health condition that can develop after experiencing or witnessing a traumatic event. The patient's symptoms suggest that he is constantly reliving the traumatic event, experiencing hyperarousal, and having difficulty concentrating, which are common symptoms of PTSD.Rate this question:
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- 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
Correct Answer
A. Cluster headachesExplanation
Based on the symptoms described, the most accurate diagnosis for Mr. Davies' headache is cluster headaches. Cluster headaches are characterized by severe, unilateral pain, stuffy nose, drooping eyelid, and flushed face. The fact that Mr. Davies has experienced similar headaches in the past, which last for a short duration and occur periodically every few months, is also consistent with cluster headaches. Migraine with aura and complicated migraine can be ruled out because they typically last longer than half an hour. Trigeminal neuralgia usually presents with sharp, shooting facial pain, which is not mentioned in the description. Muscle tension headache does not account for the specific symptoms mentioned.Rate this question:
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- 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
Correct Answer
B. Vascular syncopeExplanation
The most likely explanation for the woman's collapse and passing out is vascular syncope. Vascular syncope, also known as a fainting episode, is often triggered by a sudden drop in blood pressure, which can occur after prolonged standing, heat exposure, or physical exertion. In this case, the combination of military maneuvers in the desert, standing at attention in the sun, and possibly dehydration or fatigue could have caused her blood pressure to drop suddenly, leading to her collapse. Her quick recovery and normal behavior afterward further support this explanation.Rate this question:
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- 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
Correct Answer
C. Plaques and tanglesExplanation
Plaques and tangles are the most likely pathological findings to confirm the clinical diagnosis in this case. Plaques are abnormal clusters of beta-amyloid protein that accumulate between nerve cells in the brain, while tangles are twisted fibers of tau protein that build up inside cells. These are characteristic features of Alzheimer's disease, which is a common cause of memory difficulties and cognitive decline in older individuals. The gradually progressive nature of the memory difficulties over 8 years, along with the unrevealing workup, further support the likelihood of Alzheimer's disease as the diagnosis.Rate this question:
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- 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
Correct Answer
B. A middle cerebral artery distribution stroke with an anterior (Broca’s type) apHasiaExplanation
The patient's symptoms of right-sided weakness of the arm more than the leg and difficulty with speech, specifically with repeating and finding the right words, are consistent with a middle cerebral artery distribution stroke. This type of stroke often affects the dominant hemisphere of the brain, leading to language deficits. The mention of "Broca's type" aphasia further supports this correlation, as Broca's area, located in the frontal lobe of the dominant hemisphere, is responsible for speech production. The patient's history of uncontrolled hypertension and diabetes also increases the likelihood of a stroke.Rate this question:
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- 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
Correct Answer
C. Treat the underlying problemExplanation
The correct answer is to treat the underlying problem. In this case, the patient's symptoms of agitation, diaphoresis, tachycardia, and inappropriate behavior are likely due to a complication or side effect of the surgery. By addressing and treating the underlying issue, such as an infection or adverse reaction to medication, the patient's symptoms should improve. Treating each symptom individually or avoiding treatment altogether would not address the root cause of the problem.Rate this question:
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- 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
Correct Answer
D. HypothalamusExplanation
Concept: Clinical presentation of upper brain stem tumors in children PaCERate this question:
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- 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
Correct Answer
E. Major depressive disorderExplanation
The patient's symptoms of dysphoric mood, difficulty concentrating, sleep disturbance, appetite disturbance, back pain, headache, and fatigue are consistent with the diagnostic criteria for major depressive disorder. Major depressive disorder is characterized by a persistent feeling of sadness or loss of interest in activities, along with other symptoms such as changes in appetite and sleep patterns, fatigue, and difficulty concentrating. This diagnosis is the most likely type of mood disorder exhibited by the patient based on her symptoms and history of type II diabetes.Rate this question:
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.JPG "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?")
.JPG "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?")
.JPG "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?")
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Mar 18, 2023Quiz Edited by
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Sep 20, 2012Quiz Created by
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