Internal-Medicine

144 7: Diseases of the Nervous System
51. A 20-year-old woman presents with a history of
rapid loss of vision in one eye. Examination
reveals pain on movement of the eyeball. The
appearance of the fundi is normal, but the afferent
pupillary response is diminished. Perimetry
shows a large central scotoma. Which of the
following is the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
optic atrophy
papilledema
retrobulbar neuritis
amblyopia ex anopsia
hysteria
52. A 67-year-old man has two episodes of numbness
on the left side of his body, which last 5
minutes. He now experiences transient loss of
vision in his right eye lasting 2 minutes. On
examination, his blood pressure is 155/90 mm
Hg, pulse 80/min regular, and visual fields,
extraocular movements, and pupils are all
normal. The remaining motor and sensory
examination is also normal. Which of the following
is the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
posterior cerebral artery insufficiency
parietal lobe neoplasm
parasagittal meningioma
AVM
right internal carotid artery
atherosclerosis
53. An 18-year-old man develops fever, headache,
confusion, and generalized seizures. On examination,
he is moving all his limbs, but incoherent.
A CT scan shows bilateral, small, low-density
temporal lobe lesions. CSF shows mononuclear
cell pleocytosis, increased protein, and normal
glucose. The EEG shows bilateral periodic discharges
from the temporal leads and slowwave
complexes at regular intervals of 2–3/sec.
Which of the following is the most appropriate
next step in management?
(A)
(B)
angiography
observing response to therapy
(C)
(D)
(E)
cerebral biopsy
acute viral titers
CSF culture
54. A 24-year-old woman presents with foot and
leg weakness that is progressively getting
worse over the past 1 week. Initially, she
developed tingling in her feet and noticed that
they would drag, but now she has difficulty
standing and walking due to the leg weakness.
Three weeks ago she had a “chest cold,” which
resolved on its own. On examination, muscle
bulk is normal, motor strength is two out of
five in the quadriceps, and one out of five in
the feet. Reflexes at the ankle and knee are
absent, and sensation testing is normal. The
upper limb examination is normal. The CSF
protein is very high, glucose is normal, and
cell count is slightly elevated. Which of the following
is the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
diabetic neuropathy
alcoholic neuropathy
Guillain-Barré syndrome
cyanide poisoning
poliomyelitis
55. A 37-year-old woman complains of drooping
eyelids, double vision, and fatigue at the end of
the day. Further history reveals difficulty in
chewing food, and some weakness in climbing
stairs. 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. Her chest x-ray (CXR) is shown in
Fig. 7–2 a and b. Which of the following is the
most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
bronchogenic carcinoma
Hodgkin’s disease
teratoma
thyroid tumor with retrosternal extension
thymoma