Neurology Question Set 2

A 65-year-old male was picked up by the security personnel for voiding urine and defecating at an inappropriate place in the community. On questioning, he was making offensive remarks and behaving inappropriately. Examination by the physician shows ataxic gait and amnesia. The most likely pathological finding to be present in this person is?

A 28-year-old adolescent male presented with gradually progressive gait disturbances since 10 years of age. His gait was clumsy and slow and it was very difficult for him to perform brisk walking and running. After a few years, he developed tremors involving both upper limbs along with progressively increasing fatigability. Over last several months, his friends have noticed that his speech has become slow, slurred and sometimes incomprehensible. He also has developed difficulty in swallowing recently. On physical examination, he is vitally stable with normal sensorium and normal higher mental functions. Examination of the nervous system reveals absent deep tendon reflexes in lower extremities and extensor plantar response bilaterally. Muscle tone is normal in different muscle groups with significant distal muscle wasting in extremities. There is a marked loss of vibration and position senses, gait is ataxic and nystagmus is present. His speech is explosive and dysarthric. The neurologist suspected a specific condition and asked for genetic testing which identified two GAA trinucleotide repeat expansions. Which of the following is correct statement related to condition the patient is suffering from?

A 34-year-old woman presented with acute onset of diminished vision and haloes around lights bilaterally. This was immediately followed by severe frontal headache. Slit lamp examination of her eyes revealed mild chemosis, injection, and ciliary flush with diffuse stromal haze, along with very shallow peripheral anterior chambers with areas of iridocorneal touch in both eyes. Gonioscopy showed closed angles bilaterally and diagnosis of acute angle closure glaucoma was made. The woman was a known case of epilepsy, and she had been put on an additional anti-epileptic drug recently. However, she did not remember name of the drug. Which of the following antiepileptic drugs is most likely to be associated with secondary bilateral angle closure glaucoma?

A 52-years-old man presented with history of recurrent episodes of unilateral headache. The episodes were short lived (usually lasting for a few seconds to 3-4 minutes), with severe throbbing orbital headache, accompanied by ipsilateral conjunctival injection and lacrimation. Often, the headache seemed to be triggered by a cutaneous stimulus over face or while chewing food. Often, he used to experience countless attacks during a single day. Typically, the headache did not respond to indomethacin and other non-steroidal anti-inflammatory drugs. Which of the following drugs is likely to be least effective to as a preventive therapy?

A 47-year-old man presented with history of frequent unpleasant crawling in both his legs accompanied by urge to move the legs for last 6 months. Such symptoms were experienced mostly during periods of rest, when he would continuously move his legs, which would provide him partial relief from unpleasant feelings in legs. The symptoms were especially severe during night, on retiring on bed after returning from occupational work. Frequency of symptoms was almost 3-5 days per week. He also complained of significant daytime fatigue and sleep disturbances on most days of a week. He was advised polysomnography which revealed periodic limb movements (PLMs) during sleep. Which of the following conditions is not associated with secondary restless legs syndrome?

A 60-year-old Caucasian woman is brought to the emergency department by ambulance after suffering a general tonic-clonic seizure that lasted two minutes followed by a short period of unresponsiveness and loud breathing. Her blood pressure of 130/80 mmHg, a heart rate of 76 beats per minute, a regular and normal breathing pattern. The patient is confused but follows commands, cannot recall the events, and does not present other neurological deficits. MRI demonstrates a hypointense, contrast enhanced mass within the gray matter surrounded by significant cerebral edema. Which of the following would you expect in the tissue surrounding the described lesion?

A 28-year-old Caucasian woman visited a neurologist for 12 months of mild to moderate headache, tinnitus, retrobulbar pain, and photopsias. She has consulted several times to different general practitioners at her local walk in clinic, complaining mainly about mild to moderate headache unresponsive to nonsteroidal inflammatory medications. However, it was not until now when she decided to consult with a neurology specialist after experiencing visual disturbances and dizziness. Physical examination revealed a body temperature of 36.5 °C (97.7 °F), blood pressure (BP) of 140/80 mmHg, a regular breathing pattern, and a BMI of 29 Kg/m^2; neurological examination showed peripheral visual loss, diplopia, bilateral abducens palsy, and papilledema. An MRI did not identify extra-axial or intra-axial masses nor interstitial edema, and a lumbar puncture showed an opening pressure of 27 cm H2O, with a cerebrospinal fluid analysis within normal range. Which of the following best correspond to the pathogenic mechanism underlying these findings?

A 23-year-old male develops a seizure on the medical floor. He was admitted 2 days back with the complaints of high-grade fever and severe headache. At the time of admission, he had photophobia, neck rigidity with the following vital signs temperature of 39.5°C (103.1°F), blood pressure of 130/70 mmHg, and a heart rate of 120/ minute. A spinal fluid analysis was ordered and he was started intravenous antibiotics. On the floor, the patient's seizure terminates on its own without any medication. An MRI is performed which reveals dilation of all the ventricles of the brain. What is the most likely cause of his abnormal radiologic findings?

A 70-year-old African-American woman is brought to your office after her nurse noticed her being apathetic, easily distracted, and starting to urinate in bed, to which she seems not to care about. Her medical history is relevant for hypertension, under control with medication. Physical examination reveals a blood pressure of 138/76 mmHg, a heart rate of 70 /minute, and a regular breathing pattern. On neurological examination, she has a broad-based shuffling gait, an increased muscle tone in her limbs that is reduced by distracting the patient. There is decreased coordination with exaggerated deep tendon reflexes, decreased attention and concentration, and postural tremor. Which of the following additional features would you expect to find in this patient?

A 32-year-old woman undergoes her second-trimester ultrasound in a community hospital. During her prenatal care she was found to have mild anemia, low levels of folate, serum alpha fetoprotein levels greater than 2 multiples of the median (MoM) on two separate occasions, and a first trimester ultrasound was significant for absence of the intracranial lucency, no visualization of the cisterna magna, and posterior shift of the brain stem. This second-trimester ultrasound reports reveal widening of the lumbosacral spine ossification centers and the presence of a sac in proximity to the lumbosacral defect. Which of the following statements best describes the congenital defect in the fetus?

A 23-year-old male visits the office complaining about increasing neck pain for several months that does not improve with nonsteroidal anti-inflammatory drugs. He was involved in a motor vehicle accident 10 months ago. He further comments that he has noticed weakness and numbness in his hands, and has difficulty gripping objects. Physical examination reveals a thermal injury that he says he got while holding a hot cup of coffee a week ago when he could not feel the warmth of the coffee mug. There is bilateral decrease in power during elbow flexion and extension and wrist extension. He also has exaggerated deep tendon reflexes and decreased sensation on the dorsal and ventral surface of both forearms and hands. Which of the following findings would you expect to find in this patient?