Epidural hematomas are frequently followed by Skull fractures

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A biopsy of the spinal cord is performed, and widespread granulo­mas are found at the level of the patchy irregularity seen on MRI. 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, the most likely cause of the lesion is

  1. Taenia solium

  2. Entamoeba histolytica

  3. *Schistosoma mansoni

  4. Schistosoma japonicum

  5. Treponema pallidum

  • Because of the 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 submits to the surgery and is paraplegic postopera­tively with dense loss of sensation of pain and temperature below the level of T10. A follow-up aortogram should reveal

    1. Complete occlusion of the bypass graft

    2. Complete occlusion of the hypogastric artery

    3. Complete occlusion of the aorta below the tenth thoracic vertebra

    4. *No flow through the artery of Adamkiewicz

    5. No flow through the external iliac artery

  • Because the facial weakness persists despite antituberculous treat­ment, the physician decides to administer high-dose steroids. Within 1 week of the introduction of prednisone, the patient develops pain radiating down the back of his right leg and difficulty dorsiflexing the right foot. This new complaint probably represents which of the following disorders?

    1. *Borrelia radiculopathy

    2. Diabetic mononeuritis multiplex

    3. Isoniazid neuropathy

    4. Rifampin toxicity

    5. Tuberculous radiculopathy

  • 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 spinal segments

    1. S3-S4

    2. S2-S3

    3. S1-S2

    4. L4-L5

    5. *L2-L3

  • A 51-year-old factory worker has noticed progressive weakness over the past year. Examination and testing reveal a painless largely motor peripheral neuropathy. Of the following agents, the one most likely to be etiologic in this case is

    1. *Lead

    2. Manganese

    3. Thallium

    4. Cyanide

    5. Mercury

  • A very thin elderly woman complains of left-sided neck pain. Her family attempted to give her a deep intramuscular injection of steroids. She complains acutely of pain radiating down her arm and develops a wrist­drop. The probable site of injection is the

    1. *Posterior cord of the brachial plexus

    2. Medial cord of the brachial plexus

    3. Lateral cord of the brachial plexus

    4. Thl spinal root

    5. C5 spinal root

  • A 27-year-old man undergoes general anesthesia for a hernia repair-As the anesthesia begins, his jaw muscles tense and he becomes generally rigid. He becomes febrile, tachycardic, and tachypneic. Intravenous admin­istration of which agent may be lifesaving?

    1. Suxamethonium

    2. Nitrous oxide

    3. Succinylcholine

    4. *Dantrolene

    5. Phenobarbital

  • A 66-year-old woman presents with fever and a generalized convul­sion. Neuroimaging and lumbar puncture are most consistent with a diag­nosis of herpes encephalitis. The most appropriate treatment for this patient is which of the following?

    1. Cyclophosphamide

    2. Amphotericin B

    3. Gamma globulin

    4. Methotrexate

    5. *Acyclovir

  • A 6-month-old child who develops a febrile seizure should be inves­tigated with a spinal tap because

    1. All febrile seizures justify spinal taps

    2. Most febrile seizures are due to bacterial infections

    3. Febrile seizures cause increased intracranial pressure that must be relieved by withdrawing cerebrospinal fluid (CSF)

    4. Intrathecal antiepileptics must be given

    5. *Children this age may have meningitis with no manifestations other than fever and seizures

  • A 17-year-old girl presents with subacute mental status change and left arm weakness. She had a viral illness 1 week ago and now a diagnosis of acute disseminated encephalomyelitis (ADEM) is made. ADEM is a white matter disease that is distinguishable from multiple sclerosis (MS) by its being

    1. *Monophasic

    2. Rapidly lethal

    3. Associated with brainstem and spinal cord disease

    4. Associated with magnetic resonance imaging (MRI) lesions, which may resolve

    5. Associated with inflammatory changes in the brain

  • A 57-year-old man has been diagnosed with cluster headache. Ergot­amine prophylaxis has been partially successful. The most effective means of aborting a cluster headache is

    1. *Inhaled 100% oxygen

    2. Sublingual nitroglycerin

    3. Oral methysergide

    4. Oral propranolol

    5. Dihydroergotamine suppository

  • A 33-year-old operating room nurse accidentally has blood splashed in her eyes during a procedure. The surgical resident who examines her immediately afterward notices that she has 2-mm anisocoria and sends her to the emergency room. She feels well, is alert and talkative, and has no motor dysfunction. On examination, the emergency room physician recog­nizes that the iris of the eye with the smaller pupil is pale blue, while that of the other eye is brown. The etiology of the woman's anisocoria is probably

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