1 >>The periumbilical area is innervated by which sensory dermatome? ?
- (A) C6
- (B) T2
- (C) T5
- (D) T10
2 >>A 65-year-old man has had disrupted cerebrospinal fluid flow for several years, secondary to a thoracic disk herniation. This abnormal physiologic state has resulted in the formation of a cervical cystic lesion readily apparent on MRI. Examination of this patient might reveal which of the following abnormalities? ?
- (A) Third-nerve palsy
- (B) Calf atrophy
- (C) Charcot joints
- (D) Atrophy of the intrinsic hand muscles
3 >>A 36-year-old man is being evaluated for left-hand weakness. On examination, it is readily apparent that he has atrophy of the first dorsal interosseous muscle. This may indicate damage to which of the following spinal roots? ?
- (A) C5 and C6
- (B) C6 and C7
- (C) C7 and C8
- (D) C8 and T1
4 >>A 39-year-old woman was involved in a head-on collision at approximately 40 miles per hour. She was wearing her seat belt, but still sustained a cervical cord injury from hyperflexion and extension. A cervical syrinx is most likely to evolve in this patient if there has been which of the following? ?
- (A) Intraspinal contusion
- (B) Intraspinal transient ischemia
- (C) Intraspinal hyperthermia
- (D) Intraspinal demyelination
5 >>A 19-year-old man goes swimming in an inland pond in Puerto Rico. Within a few days, he notices itching of his skin over several surfaces of his body. He is unconcerned until several weeks later when he develops lancinating pains extending down his legs and all of his toes. Over the course of just a few days, he develops paraparesis and problems with bladder and bowel control. Within 1 week, he is unable to stand and has severe urinary retention. Which of the following is the most appropriate plan of action on an emergency basis? ?
- (A) Initiate anticoagulation
- (B) Perform sensory-evoked potential testing
- (C) Order an MRI scan
- (D) Place a cervical collar
6 >>A myelogram is performed on a patient with a subacute, worsening paraparesis. The cerebrospinal fluid (CSF) and myelogram are both unremarkable except for a slight increase in the CSF protein content. A computed tomography (CT) scan of the spine is unrevealing. Plain films of the spine are completely normal. An MRI of the lumbar cord with gadolinium reveals patchy enhancement at about the L4-5 spinal cord level. Based on this information, which of the following is the most likely diagnosis? ?
- (A) An intraparenchymal ependymoma
- (B) An extraparenchymal meningioma
- (C) A syringomyelia
- (D) A transverse myelitis
7 >>A 26-year-old recent immigrant from Brazil presents to the hospital with a subacute, worsening paraparesis. The patient had worked in the lumbar industry deep in the Amazon jungle. MRI of the spinal cord is abnormal, and a biopsy reveals widespread granulomas. In the midst of one granuloma is an ovoid mass with a spine extending from one side. The pathologist interprets this as a parasitic ovum. If the pathologist is correct, which of the following is the most likely cause of the lesion? ?
- (A) Taenia solium
- (B) An extraparenchymal meningioma
- (C) Schistosoma mansoni
- (D) Entamoeba histolytica
8 >>A 72-year-old man describes pain about the waist at the level of the umbilicus. The pain is often burning and occasionally shooting. It does not extend down his legs, but he has noticed some weakness in his legs at the time of the pain. With exertion, such as walking, he develops pain in his legs and a tingling sensation in his feet. He has been taking aspirin for the discomfort, but has noticed no substantial change in the sensation. X-rays of his spine reveal no abnormalities. Pain and weakness have become increasingly frequent over the course of several months. Because the man has had urinary hesitancy and frequency in association with an enlarged prostate, he is advised to have a transurethral prostatectomy. A general anesthetic is given for the surgery. On recovering consciousness postoperatively, the man cannot move his legs and has persistent pain at the level of the umbilicus. His plantar responses are bilaterally extensor. Which of the following is the most appropriate emergency evaluation for this patient? ?
- (A) Aortogram
- (B) Voiding cystometrogram
- (C) Electroencephalogram (EEG)
- (D) NONE
9 >>A 55-year-old man with hypertension and diabetes has a pure motor hemiparesis caused by a right thalamic stroke. The fiber tract affected by this syndrome decussates at what level? ?
- (A) At the junction of the medulla and the spinal cord
- (B) At the junction of the midbrain and the medulla
- (C) At the junction of the pons and the medulla
- (D) At the thalamus
10 >>Physical examination of a patient who has had a spinal cord infarct reveals preservation of some sensation in the feet. Which of the following would be the most intact modality? ?
- (A) Joint proprioception
- (B) Pain
- (C) Temperature
- (D) Two-point discrimination
11 >>A 67-year-old man who has smoked heavily for 45 years describes that with exertion, such as walking, he develops pain in his legs and a tingling sensation in his feet. X-rays of his spine reveal no abnormalities. Pain and weakness have become increasingly frequent over the course of several months. The pain and weakness described by the patient with exertion is probably a manifestation of which of the following? ?
- (A) Myotonia
- (B) Myokymia
- (C) Spinal claudication
- (D) Spondylolisthesis
12 >>A 67-year-old diabetic man underwent repair of an abdominal aortic dissection. The procedure seemed to go well; however, the patient awoke with an upper motor neuron pattern of weakness in both of his lower extremities. Sensation for light touch and joint proprioception were relatively preserved. The CSF analysis associated with this patient’s condition is which of the following? ?
- (A) A protein content of greater than 45 mg/dL
- (B) An increase in the CSF gamma globulin content
- (C) A depressed CSF glucose content
- (D) More than 100 red blood cells (RBCs) per ?L
13 >>A patient with a spastic paraparesis has an obvious aortic aneurysm discovered on aortography. The vascular surgeon consulting on the case recommends a bypass procedure. Preoperatively, the patient showed substantial recovery of leg strength and sensation, despite the persistence of bilateral Babinski (plantar extensor) signs. The patient undergoes the surgery and is paraplegic postoperatively with dense loss of sensation of pain and temperature below the level of T10. A follow-up aortogram would be expected to reveal which of the following? ?
- (A) No flow through the artery of Adamkiewicz
- (B) Complete occlusion of the bypass graft
- (C) Complete occlusion of the hypogastric artery
- (D) Complete occlusion of the aorta below the tenth thoracic vertebra
14 >>A 32-year-old man living along the coast of Massachusetts presents with an acutely evolving left facial weakness. Although he has no facial pain or numbness, he does have a diffuse headache. He has no history of diabetes mellitus or other systemic illnesses, but he does report newly appearing joint pains and a transient rash on his right leg that cleared spontaneously more than 1 month prior to the appearance of the facial weakness. On examination, he has mild neck stiffness and pain on hip flexion of the extended leg. This man is at highest risk for which of the following causes of a unilateral facial weakness? ?
- (A) Human immunodeficiency virus (HIV)-associated neuropathy
- (B) Lyme neuropathy
- (C) Diphtheritic polyneuropathy
- (D) Tuberculous meningitis
15 >>A 62-year-old man is being treated for tuberculous meningitis with isoniazid and rifampin. To avoid additional signs of neuropathy, which of the following agents should be administered along with these antibiotics? ?
- (A) Ceftriaxone
- (B) Thiamine
- (C) Eryth0romycin
- (D) Pyridoxine
16 >>A patient with a meningitis and facial weakness of unknown etiology had been given isoniazid and rifampin. There was no improvement, and she is treated with high-dose steroids. Within 1 week of the introduction of prednisone, she develops pain radiating down the back of her right leg and has difficulty dorsiflexing the right foot. This new symptom most likely represents which of the following disorders? ?
- (A) Borrelia radiculopathy
- (B) Diabetic mononeuritis multiplex
- (C) Isoniazid neuropathy
- (D) Rifampin toxicity
17 >>A 12-year-old boy with Lyme disease and bilateral facial weakness is being treated with a cephalosporin. The child’s facial strength improves, but he notices twitching of the left corner of his mouth whenever he blinks his eye. This involuntary movement disorder is probably an indication of which of the following? ?
- (A) Sarcoidosis
- (B) Aberrant nerve regeneration
- (C) Recurrent meningitis
- (D) Mononeuritis multiplex
18 >>A 25-year-old woman is being examined by her physician. The knee jerk is being tested. The patellar tendon reflex involves sensory fibers of the femoral nerve that originate in which of the following spinal segments? ?
- (A) S3 to S4
- (B) L2 to L3
- (C) L4 to L5
- (D) S1 to S2
19 >>A 51-year-old factory worker has noticed progressive weakness over the past year. Examination and testing reveal a painless largely motor peripheral neuropathy. Which of the following agents is most likely to be etiologic in this case? ?
- (A) Lead
- (B) Manganese
- (C) Thallium
- (D) Cyanide
20 >>A 29-year-old woman presents with weakness in several muscles in different limbs. The pattern is lower motor neuron and does not fit with any particular peripheral, plexus, or root localization. Which of the following is the most common cause of mononeuropathy multiplex? ?
- (A) Diabetes mellitus
- (B) Temporal arteritis
- (C) Sarcoidosis
- (D) Systemic lupus erythematosus