Internal-Medicine

140 7: Diseases of the Nervous System
26. A 24-year-old man presents with mild jaundice,
tremor, and personality changes. Examination
reveals slowness of finger movement, rigidity,
and coarse tremor of the outstretched hands.
As well there is abnormal slow movement of
the tongue and pharynx resulting in a change
in speech and occasional difficulty swallowing.
He is icteric, the liver span is 10 cm, and no
spleen is palpable. Which of the following findings
is most likely seen in this condition?
(A)
(B)
(C)
(D)
(E)
a reduction of copper excretion in the
urine
an increase of the serum ceruloplasmin
content
no renal involvement
retention of normal neurologic
movements
a peculiar greenish-brown pigmentation
of the cornea
27. A 52-year-old man complains of episodes of
severe unilateral, stabbing facial pain that is
intermittent for several hours, and then disappears
for several days. The pain is describes as
“electric shock-like” and only lasts a few seconds.
Physical examination of the face and
mouth is entirely normal. Which of the following
treatments is most effective for this condition?
(A)
(B)
(C)
(D)
(E)
morphine
indomethacin
cimetidine
carbamazepine
lidocaine (Xylocaine) gel
28. A 63-year-old woman develops symptoms of
nausea, vomiting, and dizziness, which she
describes as a to-and-fro movement of the room
like as if she is on a boat. Which of the following
findings suggests the vertigo is central in origin?
29. A 30-year-old woman complains of double
vision, and easy fatigue with exercise. The
fatigue improves with resting, but it is interfering
with her work. Examination reveals
ptosis and impaired eye movements with
normal pupillary response. The double vision
is brought out by asking her to look at the ceiling,
and after a sustained interval, the eyes
slowly drift down. Which of the following is
the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
optic atrophy
ophthalmic zoster
paralysis agitans
Horner syndrome
myasthenia gravis
30. A 47-year-old woman presents with increasing
headaches and visual changes. On examination,
her pupils are normal and reactive
to light, the extraocular movements are
normal, and there are visual field defects of
the outer half in both eyes (bitemporal hemianopsia).
Which of the following is the most
likely diagnosis?
(A)
(B)
(C)
(D)
(E)
pituitary adenoma
falx meningioma
craniopharyngioma
aneurysm of the internal carotid artery
glioblastoma
31. A 45-year-old man presents with weakness and
fasciculations in his arms and legs. His cranial
nerves are normal, but there is weakness of his
left handgrip and right leg quadriceps with
loss of muscle bulk. There are obvious fasciculations
over the left forearm and right thigh.
Tone is increased in the arms and legs and the
reflexes are brisk. Which of the following is the
most likely diagnosis?
(A)
deafness
(A)
amyotrophic lateral sclerosis (ALS)
(B)
(C)
(D)
symptoms are more protracted but less
severe
unidirectional nystagmus
visual fixation inhibits vertigo and
nystagmus
(B)
(C)
(D)
(E)
myotonic muscular dystrophy
amyotonia congenita
tabes dorsalis
migraine
(E)
spinning sensation is toward the fast
phase of nystagmus