1 >>A very thin elderly woman is having left-sided neck pain. Her family physician attempted to give her a deep intramuscular injection of steroids. She then developed an acute pain radiating down her arm and a subsequent wristdrop. Which of the following is the probable site of injection? ?
- (A) Posterior cord of the brachial plexus
- (B) Medial cord of the brachial plexus
- (C) Lateral cord of the brachial plexus
- (D) T1 spinal root
2 >>A 17-year-old woman has weakness of left shoulder abduction and elbow flexion, with good strength in hand and forearm muscles. Which of the following is most likely to cause an injury limited to the upper brachial plexus? ?
- (A) Node dissections in the axilla
- (B) Birth trauma
- (C) Aneurysm of the subclavian artery
- (D) Pancoast tumor
3 >>The most prominent areas of degeneration with Friedreich disease are in which of the following areas? ?
- (A) Cerebellar cortex
- (B) Inferior olivary nuclei
- (C) Anterior horns of the spinal cord
- (D) Spinocerebellar tracts
4 >>A 20-year-old ataxic woman with a family history of Friedreich disease develops polyuria and excessive thirst over the course of a few weeks. She notices that she becomes fatigued easily and has intermittently blurred vision. Which of the following is the most likely explanation for her symptoms? ?
- (A) Inappropriate antidiuretic hormone
- (B) Diabetes mellitus
- (C) Panhypopituitarism
- (D) Progressive adrenal insufficiency
5 >>A 27-year-old, right-handed man has 1 week of progressive ascending weakness. Examination confirms a lower motor neuron pattern, and cerebrospinal fluid (CSF) protein is elevated. In retrospect, the weakness was preceded by a severe episode of diarrhea. Which of the following is the most frequent preceding infection before the onset of Guillain-Barr� syndrome? ?
- (A) Campylobacter jejuni
- (B) HIV
- (C) Chlamydia psittaci
- (D) Mycoplasma pneumoniae
6 >>Friedreich disease has been consistently linked to a defect on which of the following chromosomes? ?
- (A) Chromosome 21
- (B) Chromosome 9
- (C) Chromosome 6
- (D) The Y chromosome
7 >>A young couple comes to your office because of a family history of Friedreich ataxia. They are in the process of family planning and have several questions regarding the disease. If a patient with Friedreich ataxia has children, at what stage of life would a child be expected to become symptomatic if the disease was inherited? ?
- (A) Neonatal period
- (B) Juvenile period
- (C) Early adulthood
- (D) Middle age
8 >>A 17-year-old man presents with 10 days of progressive tingling paresthesias of the hands and feet followed by evolution of weakness of the legs two evenings before admission. He now has back pain. He has a history of a diarrheal illness 2 weeks prior. On examination, he has moderate leg and mild arm weakness, but respiratory function is normal. There is mild sensory loss in the feet. He is areflexic. Mental status is normal. Spinal fluid analysis in this case is most likely to show which of the following? ?
- (A) No abnormalities
- (B) Elevated protein level
- (C) Elevated white blood cell (WBC) count
- (D) NONE
9 >>The peripheral neuropathy that would be expected to be seen in a patient with Friedreich disease develops in part because of degeneration in which of the following? ?
- (A) Dorsal root ganglia
- (B) Spinocerebellar tracts
- (C) Anterior horn cells
- (D) Clarke column
10 >>A 23-year-old woman develops progressive weakness of the extremities over the course of 1 week. She has further evolution of weakness involving muscles of the arms, face, and respiration. Eventually, she is intubated and placed in the intensive care unit. Nerve conduction and electromyogram (EMG) studies show widespread peripheral demyelination. Therapy with which of the following may help to speed recovery? ?
- (A) Corticosteroids
- (B) Cyclophosphamide
- (C) Plasma exchange
- (D) Albumin infusions
11 >>A 26-year-old woman develops acute onset of left shoulder pain. Over the following week, she develops weakness in the proximal left arm and mild sensory loss. On examination, she has scapular winging and marked weakness of the left deltoid, biceps, and triceps muscles. The right side is normal, as are her legs. Mild sensory loss in the upper arm is found. She has lost her biceps and triceps reflexes. Her brother recently had a similar problem. ?
- (A) Corticosteroids
- (B) Cyclophosphamide
- (C) Plasma exchange
- (D) Parsonage-Turner syndrome (brachial plexopathy)
12 >>A 4-year-old Jewish child has a history of poor sucking at birth, as well as multiple respiratory infections during childhood. He is of short stature and has not been able to eat due to progressive vomiting. On examination, strength is normal, but he is hyporeflexic. There is sensory disassociation, with loss of pain and temperature sensation and preservation of tactile and vibratory sense. The corneas are ulcerated, pupils do not react, and he has orthostatic hypotension. ?
- (A) Diabetes mellitus
- (B) Temporal arteritis
- (C) Riley-Day disease (familial dysautonomia)
- (D) Systemic lupus erythematosus
13 >>A 56-year-old woman has slowly worsening numbness and paresthesias of the hands and feet, as well as proximal muscle weakness. Bulbar muscles are normal. An EMG shows multifocal conduction block, slowing of nerve conduction, and minimal loss of amplitude of muscle action potentials. CSF examination shows an elevation in protein to 260, but no increase in the number of cells. ?
- (A) Corticosteroids
- (B) Cyclophosphamide
- (C) Plasma exchange
- (D) Chronic inflammatory demyelinating polyneuropathy (CIDP)
14 >>A 40-year-old police officer is given pain medications after a femoral fracture. One week later, he presents with confusion, psychosis, abdominal pain, and vomiting. On examination, he is tachycardic, hypertensive, and febrile. He appears delirious. His arms are weak, sensation is relatively preserved, and he is areflexic. His wife relates that he had similar episodes before, when he was in the military. ?
- (A) Cerebellar cortex
- (B) Inferior olivary nuclei
- (C) Panhypopituitarism
- (D) Acute intermittent porphyria
15 >>A 49-year-old dentist has a pins-and-needles sensation in her feet developing over the course of 3 months. Results of her serum chemistries, blood count, and urinalysis are all normal, but her hematocrit is at the lower limit of normal. She has a positive Lhermitte sign (electrical pain down the back on flexion of the neck). EMG and nerve conduction studies reveal slowed conduction in her sensory nerves. There is no family history of similar problems. ?
- (A) Cerebellar cortex
- (B) Inferior olivary nuclei
- (C) Panhypopituitarism
- (D) Nitrous oxide poisoning
16 >>A 25-year-old woman with a prior history of visual loss in the left eye and a spastic gait develops impaired pain and temperature perception in her feet. She was diagnosed with multiple sclerosis (MS) shortly after her visual loss. Her left fundus reveals optic atrophy, and her facial movements are asymmetric. Chest x-ray reveals large hilar lymph nodes. Mammogram reveals no apparent carcinoma ?
- (A) Neonatal period
- (B) Juvenile period
- (C) Early adulthood
- (D) Sarcoidosis
17 >>A 41-year-old homeless man has a severe burning sensation in his feet. Vibration, position, pain, and temperature senses are all impaired in both of his lower extremities up to the level of the midcalf. He admits to drinking 1 pt of vodka daily. He was operated on in the past for bleeding from esophageal varices. ?
- (A) Cerebellar cortex
- (B) Inferior olivary nuclei
- (C) Panhypopituitarism
- (D) Thiamine deficiency
18 >>A 55-year-old alcoholic man is brought in to the emergency room in a confused but nonagitated state. Significant examination findings include ophthalmoparesis, nystagmus, and ataxia. Emergency administration of which of the following medications is appropriate in the treatment? ?
- (A) Glucose
- (B) Magnesium sulfate
- (C) Pyridoxine
- (D) Thiamine
19 >>A 66-year-old woman presents with weakness worsening over the past 3 hours. The weakness began in her face, but now involves most of her body. She had made her own jam several months before and tasted a sample of it early this morning prior to discarding it because it smelled rancid. On further electrophysiologic testing, which of the following abnormalities would be most characteristic of this patient’s illness? ?
- (A) Abnormal visual evoked responses (VERs)
- (B) Abnormal brainstem auditory evoked potentials
- (C) Posttetanic potentiation of the compound muscle action potential
- (D) Conduction block
20 >>A 6-month-old child is brought to the emergency room after having a generalized seizure at home. She is found to have a temperature of 102.5°F (39.16°C). Which of the following correctly reflects why this patient should be investigated with a spinal tap? ?
- (A) All febrile seizures justify spinal taps.
- (B) Most febrile seizures are due to bacterial infections.
- (C) Febrile seizures cause increased intracranial pressure that must be relieved by withdrawing cerebrospinal fluid (CSF).
- (D) Children this age may have meningitis with no manifestations other than fever and seizures.
Leave a Reply