Category: NeuroSurgery

A 29-year-old woman has progressive gait disorder and dysmetria. Laboratory studies include a hematocrit of 55% and a routine urinalysis, which reveals excess protein and some RBCs in the urine. Urine culture is negative. The initial physical examination reveals an enlarged liver and spleen. Additional physical findings will most likely include which of the following?

a. A Kayser-Fleischer ring around the cornea

b. Hypopigmented (ash-leaf) spots on the trunk

c. Telangiectasias in the fundi on retinal examination

d. Bilateral hearing loss

e. Generalized hyporeflexia

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An infant has a head CT performed because of a large head and failure to thrive. The diagnosis of hydrocephalus is made. Congenital hydrocephalus may develop as a consequence of which of the following first-trimester maternal disorders?

a. Complicated migraine

b. Viral infection

c. Pseudotumor cerebri

d. Chorea gravidarum

e. Intervertebral disk herniation

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A 64-year-old woman slips and falls on an icy sidewalk. She hits the side of her head on the curb. After a momentary loss of consciousness she recovers, but is in some pain. Fifteen minutes later her level of consciousness begins to fluctuate and she is brought to the emergency room comatose. Magnetic resonance imaging (MRI) of the patient’s head within the first few hours of injury should reveal which of the following?

a. A normal brain

b. Intracerebral hematoma

c. Temporal lobe contusion

d. Subarachnoid hemorrhage

e. Epidural hematoma

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A 37-year-old alcoholic man awakes with clumsiness of his right hand. Neurologic examination reveals poor extension of the hand at the wrist. He most likely has injured which one of the following nerves?

a. Median nerve

b. Brachioradialis nerve

c. Musculocutaneous nerve

d. Radial nerve

e. Ulnar nerve

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An 18-year-old boy is brought into the emergency room after a diving accident. He is awake and alert, has intact cranial nerves, and is able to move his shoulders, but he cannot move his arms or legs. He is flaccid and has a sensory level at C5. Appropriate management includes which of the following?

a. Naloxone hydrochloride

b. Intravenous methylprednisolone

c. Oral dexamethasone

d. Phenytoin 100 mg tid

e. Hyperbaric oxygen therapy

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