Internal-Medicine

142 7: Diseases of the Nervous System
38. A 52-year-old man, with poorly controlled
hypertension in the past, presents with
increasing headache, confusion, and vomiting.
His blood pressure is 230/125 mm Hg,
pulse 60/min, respirations 24/min, and there
is papilledema. He has no focal deficits.
(SELECT ONE)
39. A 24-year-old man has a history of recurrent
throbbing headaches. He suddenly develops
mild right-sided weakness. His blood pressure
in the past has been normal but is now slightly
elevated. (SELECT ONE)
Questions 40 through 42
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
hyperkalemia
facial nevi
weakness and atrophy of the hands
hypokalemia
mental retardation
fasciculations
hypercalcemia
convulsions
For each patient with a neurologic condition,
select the most likely associated findings.
40. A 20-year-old man develops fatigue and severe
muscle weakness of his limbs usually after
eating a large meal. He is diagnosed with familial
periodic paralysis. (SELECT ONE)
41. An 11-year-old girl with a diagnosis of tuberous
sclerosis (SELECT THREE)
42. A 23-year-old woman with impaired pain and
temperature sensation in her arms but normal
light touch. A CT scan reveals dilatation of the
central part of the spinal cord in the cervical
region (syringomyelia). (SELECT TWO)
DIRECTIONS (Questions 43 through 58): Each of
the numbered items in this section is followed by
answers. Select the ONE lettered answer that is
BEST in each case.
43. A 27-year-old woman complains of double
vision and fatigue at the end of the day. Further
history reveals difficulty in chewing food, and
some weakness in climbing stairs. She has
stopped running because of easy leg fatigue
and leg weakness. The symptoms improve
with resting. On examination, there is weakness
of the eyelids, masticatory muscles, and
thigh flexors. Her handgrip decreases with
repetitive action. There is no sensory abnormality,
and reflexes are normal. Which of the
following is the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
hypercalcemia
myasthenia gravis
multiple sclerosis
thyroid storm
meningeal lymphoma
44. A 20-year-old man suffered a significant closed
head injury after a diving accident. He is left
with minor memory impairment but makes a
full recovery. A few months later, he has a witnessed
loss of consciousness with some arm
and leg twitching. After the event, he is disoriented
for 2 hours and then gradually returns to
baseline. There was no incontinence or tongue
biting, and his examination is normal. Which of
the following is the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
syncope
generalized seizure
focal seizure
cardiac arrhythmia
drop attack
45. A 22-year-old woman presents with fever,
headache, and confusion. She has not been herself
for the past 2 days, including not going to
work and forgetting events. On examination,
she is moving all her limbs, but not oriented to
place or time. The remaining examination is
normal. A CT scan shows bilateral, small, lowdensity
temporal lobe lesions. Cerebrospinal
fluid (CSF) shows mononuclear cell pleocytosis,
increased protein, and normal glucose. The
electroencephalogram (EEG) shows bilateral
periodic discharges from the temporal leads
and slow-wave complexes at regular intervals