Internal-Medicine

Questions: 38–50 143
of 2–3/sec. Which of the following is the most
appropriate treatment for her condition?
(A)
(B)
(C)
(D)
(E)
penicillin
chloramphenicol
acyclovir
erythromycin
steroids
increased tone of both legs with weakness,
clonus, extensor plantar responses, and brisk
reflexes. There is also loss of vibration and position
senses in the feet. The upper extremities
are normal. A clinical diagnosis of tropical
spastic paraparesis (TSP) is made. Which of
the following is the most likely cause of this
condition?
46. A 67-year-old woman with hypertension presents
with sudden onset of headache, vomiting,
and left-sided weakness. On examination, she
has weakness of the left face, hand, and leg
(graded three out of five), blood pressure of
180/100 mm Hg, and respiration of 20/min.
Which of the following is the most appropriate
initial diagnostic test?
(A)
(B)
(C)
(D)
(E)
human immunodeficiency virus (HIV)
infection
cytomegalovirus (CMV) infection
human T-cell lymphotropic virus
(HTLV)-1 infection
thiamine deficiency
central nervous system (CNS) tuberculosis
infection
(A)
(B)
(C)
(D)
(E)
CT scan with contrast
MR scan with gadolinium
CT scan without contrast
MR cerebral angiogram
conventional cerebral angiogram
47. A 77-year-old woman develops acute hoarseness,
difficulty swallowing, dizziness, and
falling to the right side. On examination, there is
decreased sensation to pain on the right side of
her face and left side of her body. The palate
and pharynx move very little on the right side,
and there is loss of coordination of the right
arm and leg. Motor power in the arms and legs
is normal. While attempting to walk, she falls
to the right side, and complains of vertigo.
An MRI scan confirms the diagnosis of the
ischemic stroke. Which of the following is the
most likely location of the stroke?
(A)
(B)
(C)
(D)
(E)
right medial medulla
right lateral medulla
right internal capsule
right parietal cortex
right cerebellum
48. A 27-year-old woman, a recent immigrant
from the Caribbean basin, has had progressive
leg weakness. Physical examination reveals
49. A 40-year-old woman complains of episodes
of severe unilateral, stabbing facial pain that is
intermittent for several hours, and then disappears
for several days. Physical examination is
entirely normal. Which of the following is the
most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
trigeminal neuralgia
herpes zoster
acoustic neuroma
Bell’s palsy
diabetic neuropathy
50. A 63-year-old man suddenly becomes acutely
ill with headache and fever of 38.9°C. There is
pain in the eye, and the orbits are painful to
pressure. There is edema and chemosis of the
conjunctivae and eyelids, and the eye bulbs are
proptosed. Diplopia and ptosis are present, and
the pupils are slow in reacting. Which of the
following is the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
cavernous sinus thrombosis
chorioretinitis
subarachnoid hemorrhage
brain abscess
none of the above