PROBLEM IN NEUROLOGY

Cerebral cortex that histologically shows numerous neuritic plaques along with neurofibrillary tangles and amyloid angiopathy is most consistent with which of the following histories:

A A 48-year-old male with choreiform movements

B A 30-year-old female with sudden loss of consciousness

C A 44-year-old male with progressive muscular weakness

D A 40-year-old female with Down's syndrome

E A 2-year-old boy with blindness and decreased neurologic function

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A 69-year-old male with a history of a remote myocardial infarction is found at autopsy to have a 4-cm diameter area of softening in the region of the left middle cerebral artery distribution. This is most consistent with:

A Vasculitis

B Thromboembolization

C Venous thrombosis

D Hypertension

E Mycotic aneurysm

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A 50-year-old female has had right-sided headaches for 5 years, but recently noted mild weakness in her left hand. A CT scan shows a well circumscribed lateral mass compressing the right hemisphere at the frontal-parietal junction. This is probably a:

A Medulloblastoma

B Metastatic carcinoma

C Schwannoma

D Glioblastoma multiforme

E Meningioma

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A 65-year-old male has been healthy all his life until he experiences a sudden grand mal seizure. A neurologic exam reveals no focal abnormalities. A brain MR scan reveals a poorly demarcated large mass with central necrosis in the right frontal lobe. The most likely diagnosis is:

A Glioblastoma multiforme

B Medulloblastoma

C Low grade astrocytoma

D Meningioma

E Choroid plexus tumor

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A 35 year old male has recently experienced a severe headache accompanied by a perception of strange smells. A brain MR angiogram reveals an aneurysmal dilation of the anterior communicating artery. Which of the following statements regarding this disease processs is INCORRECT::

A These lesions are present at birth

B Subarachnoid hemorrhage could result from rupture of such a lesion

C These lesions can be associated with dominant polycystic kidney disease

D Rupture of this lesion is probably not associated with systemic hypertension

E Intraparenchymal hemorrhage could result from rupture of this lesion

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A 52-year-old male with chronic respiratory difficulty dies from bronchopneumonia. At autopsy, the anterior spinal nerve roots are atrophic, and spinal cord anterior horns show neuronal loss with gliosis. These findings are most consistent with:

A Gullain-Barre syndrome

B Poliomyelitis

C Rabies infection

D Botulism

E Amyotrophic lateral sclerosis

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A 78-year-old male who suffers ischemic injury with cerebral infarction most likely has which of the following histopathologic findings in the cerebrum a week later:

A Gangrenous necrosis

B Liquefactive necrosis

C Coagulative necrosis

D Caseous necrosis

E Fat necrosis

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During a fight at the Beacon Club in Casper, Wyoming, a patron is knocked backwards off a barstool and lands on the back of his head. He remains conscious and continues the fight until someone decides to stop the altercation by buying everyone a round of beers. Which of the following pathologic findings is most likely to be present as a consequence of this injury:

A Occipital lobe contusions

B Subarachnoid hemorrhage

C Inferior frontal lobe contusions

D Anterior pituitary necrosis

E Skull fracture with epidural hematoma

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During the prenatal period, a 19 year old female is concerned about possible neural tube defects, based upon the appearance of a "lemon sign" by ultrasonography. Which of the following laboratory tests will most strongly suggest the presence of a neural tube defect:

A Decreased human chorionic gonadotropin

B Hypochromic, microcytic anemia

C Decreased serum folate

D Increased alpha-fetoprotein

E Positive serologic test for syphilis

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Progressive spastic paraparesis, optic nerve atrophy, sensory ataxia, and marked paresthesias of the legs are most characteristic of a 44-year-old male with:

A Chronic alcoholism

B Down's syndrome

C Pernicious anemia

D Lead poisoning

E Diabetes mellitus, type I

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A 54-year-old female with headaches for the past week has a lumbar puncture performed. The cerebrospinal fluid (CSF) opening pressure is 220 mm H2O, the CSF protein 60 mg/dl, and the CSF glucose 75 mg/dl (serum glucose 105 mg/dl). A CT scan reveals a 3 cm ring-enhancing mass in the right parietal region. Biopsy of the mass reveals gliosis and fibrosis with necrosis, neutrophils, and lymphocytes. These findings most strongly suggest a diagnosis of:

A Glioblastoma multiforme

B Herpes simplex type II encephalitis

C Vascular malformation

D Subacute infarction

E Cerebral abscess

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A 38-year-old female has abrupt onset of dizziness with nausea and vomiting. These symptoms disappear in several days, and she has only mild vertigo for several more days. She probably has:

A Gullain-Barre syndrome

B Cerebral edema

C A schwannoma

D A cerebral abscess

E Vestibulitis

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