Internal-Medicine

Questions: 26–37 141
32. Which of the following is the most likely finding
in a 79-year-old woman with Parkinson’s
disease?
For each patient with neurologic symptoms, select
the most likely structural pathology.
(A)
(B)
(C)
(D)
(E)
constant fine tremor
muscle atrophy
akinesia
pupillary constriction
spontaneous remission
34. A 77-year-old woman presents with headaches
and difficulty walking. She has an unbalanced
gait and falls easily, especially when trying to
walk upstairs. The tone is normal and there are
no cerebellar findings. A CT scan reveals
enlarged ventricles. (SELECT ONE)
33. A 47-year-old man presents to the emergency
room with symptoms of dizziness and difficulty
walking. He describes his dizziness as a
spinning sensation of the room with associated
nausea and vomiting. Which of the following
findings suggests the vertigo is peripheral in
origin?
(A)
(B)
(C)
(D)
(E)
optic neuritis
tinnitus
bidirectional nystagmus
vertical nystagmus
visual fixation does not affect vertigo or
nystagmus
DIRECTIONS (Questions 34 through 42): Each set
of matching questions in this section consists of a
list of lettered options followed by several numbered
items. For each numbered item, select the
appropriate lettered option(s). Each lettered option
may be selected once, more than once, or not at all.
EACH ITEM WILL STATE THE NUMBER OF
OPTIONS TO SELECT. CHOOSE EXACTLY THIS
NUMBER.
Questions 34 and 35
(A)
(B)
(C)
(D)
(E)
(F)
(G)
aqueductal stenosis
infectious process
enlarged foramina of Luschka
nutritional deficiency
agenesis of the corpus callosum
postvaccination
acoustic neuroma
35. A 23-year-old woman presents with arm weakness,
decreasing vision in her right eye, and
difficulty with her balance. An MRI of the brain
reveals multiple demyelinating lesions. (SELECT
THREE)
Questions 36 through 39
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
basal ganglia hemorrhage
cerebellar hemorrhage
pontine hemorrhage
lobar intracerebral hemorrhage
cocaine-related hemorrhage
subarachnoid hemorrhage
arteriovenous malformation (AVM)
hypertensive encephalopathy
primary intraventricular hemorrhage
For each patient with altered level of consciousness,
select the most likely diagnosis.
36. A 67-year-old man develops coma over a few
minutes. He is unresponsive on arrival to the
hospital. He has ataxic respirations and pinpoint,
reactive pupils. Oculocephalic reflexes
are absent. There is no motor response with
noxious stimulation. (SELECT ONE)
37. A 74-year-old woman develops occipital
headache, vomiting, and dizziness. She looks
unwell, blood pressure 180/100 mm Hg, pulse
70/min, and respirations 30/min. She is unable
to sit or walk because of unsteadiness. Over
the next few hours, she develops a decline in
her level of consciousness. (SELECT ONE)