1.
A 47 y/o man is brought to ER 30 mins after a generalized tonic clonic seizure that lasted 2 mins. He had been smoking crack cocaine when the seizure began. He is unresponsive.Exam shows a 7 mm dilated left pupil that is nonreactive to light. There is drooping of the right lower face. He has intermittent decerebrate posturing in the right upper and lower limbs. Deep tendon reflexes are hyperactive on the right Babinski sign is present on the right. CT of head shows an intracerebral hemorrhage. Which of the following types of cerebral herniation is the most likely cause of the condition.
A. Central
B. Cerebellar tonsillar
C. Subfalcine
D. Transtentorial
E. Upward
2.
3 days after admission to the hospital b/c of an 8 hour history of weakness and numbness of the right side of the face and right upper extremities, a 32 y/o woman becomes comatose. On admission, she was treated with aspirin. She has fibromuscular dysplasia. Her pulse is 40/min, and BP is 160/100. She is not responsive to verbal or tactile stimuli. Exam shows an 8 mm left pupil that is nonreactive and a 3 mm right pupil that is reactive. Her left eye is deviated outward. There is occasional movement of the left hand and foot and no movement of the right side of the face or right extremities. Deep tendon reflexes are 4 + in the right upper and lower limbs. Babinski sign is present on the right. Her serum Na is 131. What’s the diagnosis?
A. Cerebellar hematoma
B. Metabolic encephalopathy
C. Midbrain hemorrhage
D. Pontine infarction
E. Uncal herniation
3.
3. A 26 month old boy is brought in for a follow up exam 2 weeks after completing a 10 day course of amoxicillin for an ear infection. His father is concerned b/c his son has had many ear infections since birth, and his speech is difficult to understand. The child walks and runs with only occasional falls and is able to climb on furniture. He can stack seven blocks without difficult. He is at the 10th percentile for height and weight. During the exam, he doesn’t say any intelligible words, and he intermittently babbles or screams. Exam shows retracted tympanic membranes with poor movement with pneumatic otoscopy. Which is the next best step?
A. reassurance
B. Measurement of blood lead concentration
C. Audiometry
D. CT scan of the head
E. 10 day course of high dose amoxicillin-clavulanate
F. Insertion of tympanostomy tubes
4.
A 52 y/o man comes to the doc b/c of a 1 month history of numbness and tingling of the ring and small fingers of his right hand that radiates to his palm. His symptoms are not constant and exacerbated at night. He has a 2 week history of decreased grip strength and wasting of the small muscles in his right hand. He has not had neck or arm pain. 4 months ago, he was diagnosed with pancreatic cancer, since then, he underwent Whipple procedure and is currently receiving chemo with gemcitabline. Since his diagnosis, he has had significant fatigue and an 18 kg weight loss. He is 173 tall and weighs 54kg. BMI is 18. His temp is 37, pulse is 95, and BP is 120/79. There is wasting of the interosseous muscles on the right. Muscle strength is 3/5 in the right interosseous and hypothenar muscles and flexor digitorum profundus of the ring and small fingers. It is full elsewhere. Deep tendon reflexes are 2+ throughous. Babinski sign is absent. Sensdation to pinprick and temp is temp is decreased over the ulnar aspect of the palm and dorsum of the hand ring and small fingers; proprioception is intact. The remainder of the neurologic exam shows no abnormalities. Which is the cause of his symptoms.
A. C8 nerve root infiltration by tumor
B. Cervical disc herniation
C. Chemotherpay neurotoxicity
D. Ulnar nerve compression
E. Vit B12 def.
A 47 y/o man is brought to ER 30 mins after a generalized tonic clonic seizure that lasted 2 mins. He had been smoking crack cocaine when the seizure began. He is unresponsive.Exam shows a 7 mm dilated left pupil that is nonreactive to light. There is drooping of the right lower face. He has intermittent decerebrate posturing in the right upper and lower limbs. Deep tendon reflexes are hyperactive on the right Babinski sign is present on the right. CT of head shows an intracerebral hemorrhage. Which of the following types of cerebral herniation is the most likely cause of the condition.
A. Central
B. Cerebellar tonsillar
C. Subfalcine
D. Transtentorial
E. Upward
2.
3 days after admission to the hospital b/c of an 8 hour history of weakness and numbness of the right side of the face and right upper extremities, a 32 y/o woman becomes comatose. On admission, she was treated with aspirin. She has fibromuscular dysplasia. Her pulse is 40/min, and BP is 160/100. She is not responsive to verbal or tactile stimuli. Exam shows an 8 mm left pupil that is nonreactive and a 3 mm right pupil that is reactive. Her left eye is deviated outward. There is occasional movement of the left hand and foot and no movement of the right side of the face or right extremities. Deep tendon reflexes are 4 + in the right upper and lower limbs. Babinski sign is present on the right. Her serum Na is 131. What’s the diagnosis?
A. Cerebellar hematoma
B. Metabolic encephalopathy
C. Midbrain hemorrhage
D. Pontine infarction
E. Uncal herniation
3.
3. A 26 month old boy is brought in for a follow up exam 2 weeks after completing a 10 day course of amoxicillin for an ear infection. His father is concerned b/c his son has had many ear infections since birth, and his speech is difficult to understand. The child walks and runs with only occasional falls and is able to climb on furniture. He can stack seven blocks without difficult. He is at the 10th percentile for height and weight. During the exam, he doesn’t say any intelligible words, and he intermittently babbles or screams. Exam shows retracted tympanic membranes with poor movement with pneumatic otoscopy. Which is the next best step?
A. reassurance
B. Measurement of blood lead concentration
C. Audiometry
D. CT scan of the head
E. 10 day course of high dose amoxicillin-clavulanate
F. Insertion of tympanostomy tubes
4.
A 52 y/o man comes to the doc b/c of a 1 month history of numbness and tingling of the ring and small fingers of his right hand that radiates to his palm. His symptoms are not constant and exacerbated at night. He has a 2 week history of decreased grip strength and wasting of the small muscles in his right hand. He has not had neck or arm pain. 4 months ago, he was diagnosed with pancreatic cancer, since then, he underwent Whipple procedure and is currently receiving chemo with gemcitabline. Since his diagnosis, he has had significant fatigue and an 18 kg weight loss. He is 173 tall and weighs 54kg. BMI is 18. His temp is 37, pulse is 95, and BP is 120/79. There is wasting of the interosseous muscles on the right. Muscle strength is 3/5 in the right interosseous and hypothenar muscles and flexor digitorum profundus of the ring and small fingers. It is full elsewhere. Deep tendon reflexes are 2+ throughous. Babinski sign is absent. Sensdation to pinprick and temp is temp is decreased over the ulnar aspect of the palm and dorsum of the hand ring and small fingers; proprioception is intact. The remainder of the neurologic exam shows no abnormalities. Which is the cause of his symptoms.
A. C8 nerve root infiltration by tumor
B. Cervical disc herniation
C. Chemotherpay neurotoxicity
D. Ulnar nerve compression
E. Vit B12 def.
