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1. A 34-year-old homeless man with a history of chronic alcohol abuse is brought to
the emergency department by the police. He is disoriented, inattentive, and largely
uncooperative with the history and examination. He is unable to stand without assistance.
When he attempts to walk, his gait is notable for short steps and a wide stance. Neurological
examination also shows lateral nystagmus when looking to either side. What treatment
should be administered immediately?

2. A 54-year-old man is brought to the emergency department for loss of consciousness. He

was in a meeting at work when he suddenly collapsed. He regained consciousness after about
10 minutes and began complaining of severe right-sided headache. He has no prior history
of headaches.
a. What is the most likely diagnosis?
b. What is the most appropriate initial diagnostic test?
c. What treatment is necessary to prevent death?

3. A 33-year-old woman is brought to the emergency department by ambulance for

difficulty breathing. She has had ptosis and difficulty swallowing for the last 6 months.
Administration of edrophonium results in temporary resolution of her ptosis. Over the next
12 hours the patients condition deteriorates to respiratory failure requiring mechanical

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a. What is the most likely diagnosis?

b. What is the most appropriate treatment for this disorder?


Rare, slow growing, often found in the frontal lobe

Benign; most common childhood supratentorial tumor
Most common malignant primary brain tumor in adults; rapidly progressive
Most commonly secretes prolactin; may cause bitemporal hemianopia
Highly malignant cerebellar tumor in children
Common primary brain tumor, typically benign


4. What brain tumor is associated with each of the following descriptions?


5. An 11-year-old boy is brought to the clinic for occasional periods of impaired consciousness
while at school. These periods last no longer than 30-45 seconds. His teacher believes the
boy is daydreaming and finds difficulty getting his attention.
a. What is the most likely cause of the patients presentation?
b. What is the treatment of choice for the patients condition?

6. A 66-year-old man presents with progressive memory loss that began about 3 years ago. His
mother died of Alzheimer disease at 75 years of age. The patients TSH and serum B12 level
are normal, and his wife and children are eager to start him on medication. What is the
most appropriate next step?

7. A 71-year-old woman presents to her physician with leg pain when walking. The pain began
about a year ago and is gradually worsening. She is generally very active and still works her
family farm. She has pain when walking downhill, but her pain improves when she walks
uphill. Sitting or lying down relieves the pain. Physical examination shows strong, equal
bilateral pulses in the feet and ankles. The feet are warm and well-perfused. Deep tendon
reflexes are absent in the ankles and 1+ at the knees. There is no motor weakness or sensory
deficit. Straight leg test is negative.
a. What imaging modality is most likely to confirm the diagnosis?
b. How is this condition treated?

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8. A 65-year-old man comes to the clinic with headache, confusion, weakness, myalgias, fever
and malaise for 3 days. He has been working at a childrens summer camp for the last 4
weeks, where mosquitoes have been prevalent. Physical examination reveals a maculopapular
rash. CSF shows elevated protein, normal glucose, and a moderate number of lymphocytes.
a. What is the most likely diagnosis?
b. What treatment is indicated?

9. Indicate whether each of the following conditions is most consistent with an upper or lower
motor neuron lesion.

Bells palsy
Transient ischemic attack
Guillain-Barr syndrome
Cauda equina syndrome

10. A 43-year-old woman comes to the clinic for electrical pain that radiates down her spine
and into her arms whenever she tilts her head downward, beginning two days ago. She has
no numbness or tingling in the extremities, although she reports that she has had episodes
of numbness in the legs in the past. She also recalls a two-week period several months ago
in which there was a dark spot in the center of her field of vision, only affecting her right
eye. There was some eye pain at that time, although the vision disturbance and pain resolved
spontaneously after about a month. Today, her physical examination shows no abnormalities.
MRI of the brain and spinal cord shows several plaques of demyelination in various stages of
healing. What is the most appropriate treatment for acute exacerbations of this disorder?

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