Internal-Medicine

138 7: Diseases of the Nervous System
16. A 40-year-old man is injured in a car accident
and fractures his left elbow. He now complains
of numbness of his fourth and fifth fingers, and
weakness in his hand grip. Neurologic findings
confirm weakness of handgrip with weakness
of finger abduction and adduction, and
decreased sensation over the fifth finger and
lateral aspect of fourth finger. Which of the following
is the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
ulnar nerve injury
radial nerve injury
median nerve injury
carpal tunnel syndrome
axillary nerve injury
17. A 31-year-old woman complains of excessive
sleepiness during the daytime for years despite
adequate nighttime sleep. She has episodes of
intense drowsiness three to four times a day,
even when at work or while eating meals. She
has sought medical attention in the past, after
falling asleep while driving. She is slender and
otherwise healthy and on no medications.
Which of the following treatments is most
likely indicated for her condition?
(A)
(B)
(C)
(D)
(E)
a device providing continuous positive
airway pressure (CPAP) at night
oral surgery
tracheostomy
amphetamines
benzodiazepines at bedtime
18. A 43-year-old man is referred from the emergency
department with memory loss and difficulty
walking. He was brought in by his wife
who has noticed personality changes, truancy
from work, and lack of personal care over the
past 2 years. On examination he appears
unkempt, smells of urine, and is uncooperative.
He cannot recall the date or season, and
gets angry when asked questions. His answers
are often fabricated when checked with his
wife. His gait is wide-based, and there is loss of
sensation in his feet up to the shins. His motor
strength and reflexes are normal. His ocular
movements are normal and there is no nystagmus.
In the past he has had multiple admissions
for alcohol withdrawal. Which of the following
is the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
Wernicke’s encephalopathy
Wernicke-Korsakoff syndrome
Alzheimer’s dementia
Charcot-Marie-Tooth disease
vascular dementia
19. A 59-year-old woman has numbness and tingling
in her feet. On examination, there are
signs of involvement of the peripheral nerves
in the form of decreased sensation, motor
weakness, and distal reflex loss. The findings
are symmetric. Which of the following medical
conditions is most likely to explain her
peripheral nerve findings?
(A)
(B)
(C)
(D)
(E)
heart disease
dermatomyositis
hypothyroidism
diabetes mellitus
adrenal insufficiency
20. A 94-year-old man presents with progressive
headaches, light-headedness, drowsiness, and
unsteady gait over 6 weeks. On examination,
his blood pressure is 160/90 mm Hg, pulse
70/min, lungs clear, and he has no focal weakness.
His gait is unsteady but sensation in the
feet is normal. A CT scan reveals a hyperintense
clot over the left cerebral cortex. Which of
the following is the most likely cause for this
clot?
(A) is venous in origin
(B) is arterial in origin
(C) is from injury to the middle meningeal
artery
(D) is from a subarachnoid hemorrhage
(E) is from injury to the middle cerebral
artery
21. A 68-year-old man has many months history of
progressive hearing loss, unsteady gait, tinnitus,
and facial pain. An MRI scan reveals a
tumor at the cerebellopontine angle. Which of
the following cranial nerves is this tumor most
likely to affect?