Internal-Medicine
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CHAPTER 7<br />
Diseases of the Nervous System<br />
Questions<br />
DIRECTIONS (Questions 1 through 32): Each of<br />
the numbered items in this section is followed by<br />
answers. Select the ONE lettered answer that is<br />
BEST in each case.<br />
1. A 69-year-old woman presents to the clinic<br />
with memory difficulty. The patient’s daughter<br />
is concerned because she is having difficulty<br />
doing her finances, such as paying bills.<br />
Memory impairment testing reveals the poor<br />
ability to generate lists of words or copy diagrams<br />
(intersecting pentagons). Her remaining<br />
physical examination is normal. Which of<br />
the following anatomic findings is most likely<br />
with her condition?<br />
(A) atrophy of the medial temporal lobes<br />
(B) atrophy of the entire frontal and temporal<br />
lobes<br />
(C) cranial nerve involvement<br />
(D) transient episodes of hemiplegia<br />
(E) atrophy of the caudate<br />
2. A 38-year-old man presents with involuntary<br />
facial grimacing, shrugging of the shoulders,<br />
and jerking movements of the limb. His father<br />
was similarly affected. There is also a history of<br />
mood changes for the past 3 months. On examination,<br />
he appears restless with intermittent<br />
slow movements of his hands and face. He has<br />
difficulty performing rapid finger movements,<br />
and tone is decreased in the upper and lower<br />
limbs. Which of the following is most likely to<br />
represent the progression of his illness?<br />
(A) a normal life span<br />
(B) a 50% chance of only male children<br />
being similarly affected<br />
(C) mental deterioration<br />
(D) eventual development of rigidity<br />
(E) development of hemiparesis<br />
3. An 18-year-old woman has periodic episodes<br />
that begin with severely decreased vision, followed<br />
by ataxia, dysarthria, and tinnitus. The<br />
symptoms last for 30 minutes and are then<br />
followed by a throbbing occipital headache.<br />
Which of the following is the most likely<br />
diagnosis?<br />
(A)<br />
(B)<br />
(C)<br />
(D)<br />
(E)<br />
vertebral-basilar insufficiency<br />
chronic basilar artery dissection<br />
classic migraine<br />
ophthalmoplegic migraine<br />
basilar migraine<br />
4. A 6-month-old child presents with recurrent<br />
seizures and poor development. The evaluation<br />
reveals a baby with hydrocephalus, impaired<br />
movement of the extremities, hypotonia, and<br />
retinal abnormalities. A computerized tomography<br />
(CT) scan demonstrates large ventricles<br />
and calcified lesions. Which of the following is<br />
the most likely diagnosis?<br />
(A)<br />
(B)<br />
(C)<br />
(D)<br />
(E)<br />
Tay-Sachs disease<br />
congenital hydrocephalus<br />
kernicterus<br />
toxoplasmosis<br />
congenital neurosyphilis<br />
135<br />
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