Internal-Medicine
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Questions: 5–15 137<br />
11. A 10-year-old boy has multiple tan-colored<br />
patches on his skin, and freckle-like skin<br />
changes in his armpit area. The rest of clinical<br />
examination is normal. Which of the following<br />
conditions is also found in patients with<br />
this disorder as they get older?<br />
(A) bilateral eighth nerve tumors<br />
(B) irregular small pupils<br />
(C) multiple cutaneous and subcutaneous<br />
tumors<br />
(D) cataracts<br />
(E) hip involvement<br />
12. A 44-year-old man presents with involuntary<br />
movements of his face, shoulders, and arms. His<br />
father had a similar condition. There is also a<br />
history of mood changes for the past 6 months.<br />
On examination, he appears restless with intermittent<br />
slow movements of his hands and face.<br />
He has difficulty performing rapid finger<br />
movements, and tone is decreased in the upper<br />
and lower limbs. Which of the following is the<br />
most likely diagnosis?<br />
(A)<br />
(B)<br />
(C)<br />
(D)<br />
(E)<br />
Parkinson’s disease<br />
Huntington’s chorea<br />
amyotrophic lateral sclerosis (ALS)<br />
spinal muscular atrophy<br />
Sydenham’s chorea<br />
13. A 56-year-old man is brought to the emergency<br />
department by his wife because of memory<br />
loss and difficulty walking. She has noticed<br />
personality changes, truancy from work, and<br />
lack of personal care over the past 1 year. On<br />
examination he appears unkempt, smells of<br />
urine, and is uncooperative. He cannot recall<br />
the date or season, and gets angry when asked<br />
questions. His answers are often fabricated<br />
when checked with his wife. The blood pressure<br />
is 150/90 mm Hg, pulse 100/min, and he<br />
is diaphoretic and tremulous. His gait is wide<br />
based, and motor strength and reflexes are<br />
normal. His ocular movements are normal but<br />
there is nystagmus on lateral gaze. In the past<br />
he has had multiple admissions for alcohol<br />
withdrawal. Which of the following is the most<br />
appropriate next step in management?<br />
(A) prophylactic phenytoin administration<br />
(B) prophylactic diazepam administration<br />
(C) prophylactic carbamazepine<br />
administration<br />
(D) calcium administration<br />
(E) steroid administration<br />
14. A 60-year-old man with diabetes acutely develops<br />
double vision and discomfort in his left<br />
eye. On examination, there is ptosis of the left<br />
eyelid, the eye is rotated down and out, and the<br />
pupil is 3 mm and reactive to light. The right<br />
eye is normal. Which of the following is the<br />
most likely diagnosis?<br />
(A)<br />
(B)<br />
(C)<br />
(D)<br />
(E)<br />
fourth nerve palsy<br />
diabetic autonomic neuropathy<br />
third nerve palsy<br />
sixth nerve palsy<br />
seventh nerve palsy<br />
15. A 48-year-old man complains of recurrent<br />
episodes of sudden-onset dizziness. He notices<br />
an abrupt onset of a spinning sensation when<br />
sitting up or lying down in bed. The symptoms<br />
last for 30 seconds and then resolve completely.<br />
He has no hearing change or other neurologic<br />
symptoms, and his physical examination is<br />
completely normal. A Dix-Hallpike maneuver<br />
reproduces his symptoms. Which of the following<br />
is the most likely mechanism for his<br />
vertigo symptoms?<br />
(A) basilar migraine<br />
(B) brain stem ischemic events<br />
(C) benign cerebellar tumors<br />
(D) calcium debris (calcium carbonate<br />
crystals) in the semicircular canals<br />
(E) Meniere’s disease
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