A 35-years-old intravenous drug abuser presents with inability to control his left hand. He repots that at times he will button his shirt with his right hand, only to find that his left hand is unbuttoning the shirt against his control. He has a history of thrush. He his alert and oriented. MRI shows an increased T2 signal affecting the subcortical white matter of the right parietal lobe without enhancement.
Which of the following is the likely organism that caused the disease? Prion protein Herpes simplex virus. Treponema pallidum JC virus Tenia solium. Treponema pallidum. .
A 65-year-old man with a history of atrial fibrillation is brought into the emergency room at 1:00 pm because of
the acute onset of right-sided weakness and inability to speak beginning at noon. On examination, he is alert
but unable to speak. He follows simple one-step commands. There is left gaze deviation and impaired
rightward gaze. Flaccid paresis of the right face and arm is present, but he is able to lift his right leg off the
bed. Reflexes are decreased on the right side.
What is the appropriate diagnostic study? MRI of the brain Brain biopsy Nerve conduction (NC) studies CSF analysis EFG Serum creatine phosphokinase (CPK) Cerebral angiography Myelography of the spinal canal Cranial computerized axial tomography (CAT) Skull x-ray.
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? Initiate anticoagulation. Perform sensory-evoked potential testing. Order an MRI scan. Place a cervical collar. Perform a spinal angiography.
A 32-year-old man develops weakness in his hands over the course of 3 months. Further questioning reveals that he is also having trouble with swallowing. He ocasionally slurs his words and has noticed progressive weakness in his cough over the preceding 4 weeks. The weakness is not substantially worse later in the day. He has no sensory symptoms associated with his weakness. Sexual function, bladder and bowel control, hearing, vision, and balance are all alleged to be unchanged. The examining physician discovers marked atrophy of the interosseous muscles of both hands. Deep tendon reflexes are hyperactive in the arms and the legs. Extensor plantar responses are present bilaterally. Rectal sphincter tone is normal. This patient's illness characteristically produces electromyographic changes that include which of the following? Fibrillations. Markedly slowed nerve conduction velocities. Impaired sensory nerve action potentials H reflexes No abnormalities.
A 38-year-old woman says that she is "dizzy.'"A more careful history reveals that she has an abnormal sensation of movement intermittently. Examination
reveals horizontal rhythmic eye movements on leftward gaze. A T1 MRl image from this patient is
shown. Electronystagmography is most likely to support which of the following diagnoses? Ocular bobbing. Pontine hemorrhage Cervicomedullary junction glioma. Episodic vertigo Brainstem stroke.
A 72-year-old man requires bypass surgery to alleviate myocardial ischemia. During surgery, he has a massive myocardial infarct and protracted asystole. Resuscitative measures succeed in reestablishing a normal sinus rhythm, but postoperatively the patient remains unconscious after 48 hours. Over the ensuing weeks, the patient's level of consciousness improves slightly. He appears awake at times, but does not interact in meaningful ways with visitors. He breathes independently and even swallows food when it is placed in his mouth, but he remains mute. With painful stimuli, he exhibits semipurposeful withdrawal of his limbs. His clinical status remains unchanged for several more months.
Which of the following is the most likely diagnosis? Hepatolenticular degeneration Hyperparathyroidism Central pontine myelinolysis Akinetic mutism MPTP poisoning Locked-in syndrome Rhombencephalitis Vegetative state Essential tremor Neuroleptic effect.
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