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CNS (102 Questions) Question 1 A blow to the head of a 25-year-old male that results in a tear of the middle meningeal

artery is most likely to be associated with: ConvEx in Epidural hematoma zzA Epidural hematoma/ bn dura and the skull/ licid period ,coma and death B Subdural hematoma ( will tearing of the venous vessels b/n dura and arachnoid-self limiting) C Subarachnoid hemorrhage D Cerebellar hemorrhage E Periorbital hemorrhage Question 2 Bacterial meningitis may result (sooner or later) in all of the following complications EXCEPT: A Hydrocephalus B Thrombosis and infarction C Abscess zzD Subdural hematoma

Here is a bilateral chronic subdural hematoma. The blood clots are brown to tan because of organization. Since the bleeding is venous, subdurals can form more slowly and insidiously than clots from arterial hemorrhages. Subdurals are mc in the very young and the elderly
E Cerebellar tonsillar herniation Question 3 Which set of histopathologic findings is **most typical for Alzheimer's disease? A Atrophy of caudate nucleus, gliosis B Wallerian degeneration, gliosis C Substantia nigra depigmentation, loss of neurons

D Group atrophy of muscle, anterior horn cell loss zzE Neurofibrillary tangles, senile plaques/1 of 3 nerodegenrative dz due to deposition of amyloid beta protein/peptide/ get cortical atrophy of the hippocampus/ memory loss

Question 4 During radical prostatectomy, the anesthesiologist reports a drop in blood pressure in a 73-year-old male. The hypotension persists for 30 minutes despite intervention with pressor agents. The most likely consequence of this prolonged hypotensive episode is: A Hydranencephaly zzB Linear parasaggital infarction

bilaterally symmetric dark discolored areas seen superiorly and just lateral to the midline represent recent infarction in the watershed zone between anterior and middle cerebral arterial circulations. Such watershed infarctions can occur with relative or absolute hypoperfusion of the brain.
C Lacunar infarcts of basal ganglia D Parietal lobe hemorrhagic infarct E Anterior pituitary necrosis Question 5 Which of the following infectious agents is most likely to produce vascular thrombosis+ infraction with infarction in the brain: A Herpes simplex virus B Toxoplasma gondii C Human immunodeficiency virus D Cytomegalovirus zzE Aspergillus/ mucor have tropism for blood vessels

Question 6 A baby is born prematurely at 29 weeks gestational age. Surfactant therapy (a steroid) is used and the baby does not develop respiratory distress. However, it is noted that the baby has a seizure during the first day of life. The most likely lesion to explain this complication is: zzA Intraventricular hemorrhage

This is intraventricular hemorrhage (IVH) which arose in the subependymal region (germinal matrix) of a 28 week gestational age newborn. The germinal matrix region is very susceptible to such lesions at this period of development, leading to IVH as a complication of prematurity.
B C D E Intracerebellar hemorrhage Subdural hematoma Subgaleal hemorrhage Epidural hemorrhage

Question 7 An increase in brain volume because of an increase in sodium and water content is most likely to be severest in:

A Neuronal cell bodies B Meninges zzC White matter D Dura E Ependyma Question 8 A 32-year-old female came to her physician because of (unilateral) eye, which had lasted only a week. She probably has: A A low grade astrocytoma XXB Multiple sclerosis/ chronic recurrent and relapsing/ mc young white women

C Embolic stroke from endocarditis D Ruptured intracranial aneurysm E Acute vasculitis Question 9 Which of the following is the most common congenital CNS malformation:

B C D E

Encephalocele Arnold-Chiari malformation Lissencephaly Holoprosencephaly

Question 10

Amniocentesis is performed at 16 weeks gestation and the amniotic fluid is found to have an elevated alpha fetoprotein. Which of the following findings seen on ultrasound examination of the fetus is most likely to be present: A Holoprosencephaly B Hydrocephalus zzC Encephalocele/ a diverticulum of malformed CNS tissue thru a defect in the caranium.mc in the posterior fossa or occipital region. D Hydrops fetalis E Spina bifida not all are exposed Question 11 Progressive multifocal leukoencephalopathy (PML) is most typically seen in patients with: mutifocal demylenation and may represent reactivation A Herpes simplex virus infection B Multiple sclerosis zzC Acquired immunodeficiency syndrome / Immuno compromised patients/it is infection of the oligodendrocytes by JC polyoma viruss( papova virus) circular dsDNA
PML IN white matter

virus) D Toxoplasmosis E Glioblastoma multiforme Question 12 A 50-year-old African-American male with [chronic] hypertension suddenly loses consciousness. When he is aroused, he cannot speak and he cannot move his right arm or his right leg. He probably has: [led to Charcot-Bouchard microaneurysm] NB this is different from berry aneurysm A An embolus to the middle cerebral artery B A meningioma C Cerebral venous thrombosis D Alzheimer's disease zzE Hemorrhage into the putamen

Question 13 A cerebellum showing anterior vermian atrophy from a patient with a history of chronic alcoholism would be most likely to be associated with which additional finding: A Choreiform movements B Nystagmus zzC Truncal and lower limb ataxia

D Tremor at rest that diminishes or disappears with movement E Short-term memory loss Question 14 A previously healthy 31-year-old female suddenly loses consciousness and is taken to the hospital where a workup reveals extensive subarachnoid hemorrhage. She is afebrile. Lumbar puncture shows 1]many red blood cells but 2]no white blood cells. What do you suspect:

A Acute bacterial meningitis zzB Ruptured berry aneurysm/ mc in anterior circulation and are near major arterial branch points. If she had headache it would be the worse of her life.

C Progressive multifocal leukoencephalitis D Tay-Sachs disease E Parkinson's disease Question 15 Which of the following statements regarding Huntington's disease is INCORRECT: zzA There is an autosomal recessive inheritance pattern. Its is AD B The patients usually become symptomatic as adults. [ complete penetrance ]. C The caudate nucleus typically becomes smaller in size. D Patients may present with choreiform movements. E Some patients develop psychosis. F It shows anticipation and genetic imprinting.

loss pig in SN Question 16

normal # of pig neu in SN/R Lewy bodies in cerebeal Cortex

A 22-year-old male suffers a deep laceration to the forearm resulting in transection of the median nerve[peripheral nerve]. Following this injury, the nerve will undergo:

zzA Wallerian degeneration B Fibrinoid necrosis C Coagulative necrosis D Segmental demyelination E Chronic inflammation Question 17 The etiology for a subdural hematoma is virtually always: traumatic vascular injury A Hypertension B Atherosclerosis C Thrombocytopenia

zzD Trauma

E Infection Question 18 Enlargement of the cerebral ventricles from obstruction to the flow of cerebrospinal fluid is LEAST likely to occur from which of the following conditions: zzA Previous meningitis from Pneumococcus B Forking of the aqueduct of Sylvius C Epidural hematoma D Ependymoma E Intraventricular hemorrhage Question 19 Vasospasm in cerebral arteries leading to infarction is most frequently a complication of:

A Bacterial meningitis B Severe atherosclerosis C Malignant hypertension D Cerebral edema zzE Subarachnoid hemorrhage// due to berry aneurysm rupture Question 20 A frozen section on a single ring-enhancing mass lesion on CT scan in the left hemisphere in a 39-year-old male shows granulation tissue with adjacent gliosis and edema. The probable diagnosis is:

zzA Chronic brain abscess mcly caused by mixed bacterial infections, but anaerobic predominate. Streptococcus, prevotella melanogeica/B. melanogenicus and fusobacterium nucleatum. Also Staph aureus( coagulase +) if IV drug user. Requires surgical drainage and antibiotic. B Aspergillosis C Progressive multifocal leukocencephalopathy D Toxoplasmosis E Rabies Question 21 A 66-year-old male is finding that he has more difficulty moving about. He is annoyed by a tremor in his hands, but the tremor goes away when he performs routine tasks using his hands. He has not suffered loss of mental ability {means ml not Alzeimers dz}. He probably has: A Amyotrophic lateral sclerosis (ALS) B Alzheimer's disease

zzC Parkinson's disease improves after mment is initiated

The loss of pigmentation in the substantia nigra of the midbrain at the left in a patient with Parkinson's disease is contrasted with a normal midbrain at the right. Parkinson's disease is marked clinically by a 1] "pill-rolling" tremor at rest,2] mask-like facies, and 3]cogwheel rigidity of limbs, among other findings.
D Niemann-Pick disease E Tuberous sclerosis Question 22 The family of a 55-year-old male is finding that he can no longer care for himself and that he cannot even remember where the bathroom in the house is. This man has: A Depigmentation of the substantia nigra zzB Many senile plaques in the cerebrum

This is a neurofibrillary "tangle" of Alzheimer's disease. The tangle appears as long pink filaments in the cytoplasm. They are composed of cytoskeletal intermediate filaments.Loss of Ach in cerebral cortex
C A granuloma near the brainstem D Multiple neurofibromas E Large, vacuolated neurons in the cerebrum Question 23

The finding of acute encephalitis with 1] hemorrhagic 2] necrosis in the temporal lobes is most typical for which of the following infectious agents: zzA Herpes simplex virus

B C D E

Influenza virus Mycobacterium tuberculosis Hemophilus influenzae Neisseria meningitidis

Question 24 Which of the following infections seen in neonates is the most frequent cause for congenital infections involving the brain: A Cysticercosis zzB Toxoplasma gondii / Cats cysts and also common infections in AIDS pts TORCHES

microglial nodule with toxoplasma pseudocysts as a consequence of infection with Toxoplasma gondii. Pseudocysts consist of an infected cell forming the cyst wall and containing the developing bradyzoites. This infection occurs in immunocompromised patients, such as in persons with AIDS. Toxoplasmosis of the brain produces small, usually multiple, abscessing lesions.
C Poliovirus D Candida E Syphilis Question 25

Small mammillary bodies that show brown discoloration or hemorrhage in a 73-year-old male are most typical for: A Multiple sclerosis B Parkinson's disease C Amyotrophic lateral sclerosis zzD Wernicke-Korsakoff syndrome

E Huntington's disease Question 26 A 50-year-old male complained of **headaches, becoming**irritable and **acting strangely about a month after being involved in a vehicular accident in which he struck the windshield, but did not lose consciousness. This history is most consistent with: A Epidural hematoma zzB Chronic subdural hematoma / slow tearing venous vessels C Cerebral contusions D Subarachnoid hemorrhage E Intracerebral hematoma Question 27 A 35-year-old male with 1]progressive, 2]symmetric muscular weakness of the extremities over the course of 3]several years most likely has: [antenteria horn cells are absent]. zzA Amyotrophic lateral sclerosis [ mutant super oxide dismutase].

B C D E

von Recklinghausen's disease Multiple sclerosis Werdnig-Hoffman disease Guillain-Barre syndrome

Question 28 Examination of the CSF from lumbar puncture shows 2 RBC's, 34,000 WBC's, glucose of 20 mg/dl{is low indicative of a bacterial infection normal ~70, of differential had benn given, then PMNL will be high} and protein of 105 mg/dl[ high]. Which of the following additional tests would be the most helpful: A Cryptococcal antigen B Acid fast stain C India ink D Serology for Herpes simplex zzE Gram stain Question 29 Multiple sclerosis (MS) is characterized by all of the following EXCEPT: A Onset in early adulthood B Oligoclonal bands in the CSF zzC Association with influenza virus infection D Plaques of demyelination in white matter**

E A relapsing and remitting course Question 30 A healthy 28-year-old male presented with acute onset of severe headache and photophobia. He had a stiff neck and a CT scan showed blood in the basal meninges. The most likely diagnosis is: A Hypertensive hemorrhage B Trauma zzC Ruptured intracranial aneurysm / complication of spasm leads to infracts.

D Glioma with hemorrhage E Thrombocytopenia Question 31 Which of the following findings is NOT characteristic of Guillain-Barre syndrome: following campy infection/ acute influenz-like illness A Ascending paralysis starting with distal muscles zzB Neurofibrillary tangles [ Alzheimers dz] C Peripheral nerve demyelination D An immunologic mechanism of injury E Elevated cerebrospinal fluid protein F Loss of deep tendon reflexes Question 32 Cerebellar tonsillar herniation would be LEAST likely to occur with: zzA Wernicke's disease B Cerebral abscess C Glioblastoma multiforme D Chronic subdural hematoma E Hypertensive intraparenchymal hemorrhage

Question 33 Duret hemorrhages in the brainstem are usually a consequence of: zzA Cerebral 1] edema with 2] uncal herniation // 3]any mass lesion/effect

B C D E

Medulloblastoma of cerebellum Hydrocephalus ex vacuo Arterial emboli Toxoplasmosis

Question 34 A 48-year-old female has lost hearing on the left, and a CT scan shows a mass in the cerebello-pontine angle. The cell of origin for this neoplasm is most likely a(an): A Astrocyte B Neuron C Oligodendrocyte zzD Schwann cell

fish flesh appearnce of ~

E Ependymal lining cell Question 35 Which of the following pathologic findings is UNLIKELY to be a feature of neurosyphilis: A Cortical neuronal loss with atrophy zzB Hemorrhagic encephalitis C Chronic meningitis D Endarteritis E Atrophy of spinal cord dorsal columns / ataxia and loss of position sense//DC-ML pathway. Question 36 A 60-year-old male with a history of transient ischemic attacks (TIA's) is most likely to have: cause CVA zzA Cerebral arterial atherosclerosis B Chronic meningitis C Cerebral venous thrombosis D A glioblastoma multiforme E Cerebral arterial vasculitis Question 37 Any of the following lesions would typically be found in a 50-year-old male with a history of chronic alcoholism EXCEPT: A Cerebral contusions zzB Basal ganglia hemorrhage C Wernicke's disease D Subdural hematoma

E Central pontine myelinolysis ***** another symmetrical dz w demyelination of the basis pintis and portions of the pontine tegmentum. Leads rapidly to quadriplegia.seen in 1. Chronic alcholism, 2. severe electrolyte/osmolar imbalance 3. othotopic liver transplant. It is believed to be due to rapid correction of hyponatrimia. Question 38 Alzheimer's disease can be characterized by all of the following EXCEPT: A Loss of choline acetyltransferase in the frontal lobe B Congo(philic) amyloid angiopathy C Onset as early as age 40 D Gene defects on either chromosomes 21, 19, and 14 in familial cases zzE Association with a previous influenza virus infection in some cases/GBS Question 39 The LEAST severe neural tube defect in a newborn would be: A Meningocele B Anencephaly zzC Spina bifida D Meningomyelocele E Encephalocele Question 40 Which of the following patients has the glioblastoma multiforme (GBM): a variant of astrocytomas [grade IV] A A 10-year-old child with seizures zzB A 55-year-old male with a right cerebral mass // seen in adults mc in the cerebral H

seeds thru the CSF

This glioblastoma multiforme (GBM) demonstrates marked cellularity with marked hyperchromatism and pleomorphism. Note the prominent

vascularity as well as the area of necrosis at the left with neoplastic cells palisading around it. This is the worst possible form of glioma--a glioblastoma multiforme (GBM). These neoplasms are quite vascular with prominent areas of necrosis and hemorrhage. Note how this one has crossed the midline to the opposite hemisphere.
C A 70-year-old male with multiple mass lesions in the cerebrum D A 30-year-old female with ataxia and polycythemia E An infant with blindness Question 41 A 53-year-old male has a 6-month course of rapidly progressive dementia culminating in death. At autopsy, the brain is grossly normal, but a spongiform encephalopathy is seen microscopically. He most likely has: A Alzheimer's disease zzB Creutzfeldt-Jakob disease

The "holes" in the cortex of the cerebrum seen here represent a spongiform encephalopathy known as JacobCreutzfeldt disease. This is a form of rapidly progressive dementia. It is due to a poorly understood prion protein that has infectious potential, but the cases appear sporadically (1 in a million).
C AIDS dementia D Rabies

E Herpes viral encephalitis Question 42 The most significant result of the Arnold- Chiari malformation is: is 1]elongation and

2]flattening of the cerebellum and medulla with protrusion down a large conical foramen magnum=Leading to hydrocephalus
A Infection B Hemorrhage zzC Hydrocephalus

D Infarction E Muscular atrophy Question 43 A 46-year-old female has a severe headache. Papilledema is noted. These findings are most likely to be a consequence of: A Blockage of lymphatics by metastatic tumor B Overproduction of cerebrospinal fluid C A neuronal storage disease D Hyperosmolar coma with diabetes mellitus zzE Neovascularization around a glioma

these vascular malformations can mimic brain tumors, leading to headaches and seizures. Question 44

Of the following findings, the one LEAST likely to occur with metastases to the brain is: A A lung primary B Presence of multiple mass lesions C Diffuse meningeal involvement zzD Guillain-Barre syndrome E Herniation Question 45 Several weeks after the appearance of an expanding ring-like rash on the forearm, a 29year-old female develops a stiff neck, left facial droop, and chest pain. These problems probably developed as a consequence of: A The bite of a deer tick B Mercury poisoning zzzC Taking a cephalosporin D Sexual intercourse E Systemic lupus erythematosus Question 46 Which of the following pairs of findings is INCORRECT: A Hepatic failure and coma B Hypoglycemia and confusion C Hyperbilirubinemia and kernicterus D Uremia and somnolence zzE Hypocalcemia and psychosis Question 47 A 20-year-old male from Mexico City experiences the sudden onset of a seizure disorder. A CT scan shows multiple rounded densities in the cortex. A stereotactic brain biopsy reveals birefringent hooklets diagnostic of: A Schistosomiasis B Malaria C Paragonimiasis D Trichinosis zzE Cysticercosis

the ingestion of poorly cook pork, containing eggs

Question 48 The peripheral neuropathy of a 47-year-old male with ***diabetes mellitus is LEAST likely to: A Affect distal nerves in the extremities more severely B Show symmetrical involvement zzC Affect motor nerves more severely D Appear even with well-controlled glucose levels E Affect axons more than dendrites Question 49 A sudden traumatic blow to the head may result in each of the following sequelae EXCEPT: A Frontal lobe contusion B Subdural hematoma C Cerebral edema D Loss of sense of smell zzE Cerebral vasculitis Question 50 A 52-year-old male with a long history of chronic alcoholism now has worsening ataxia. This is probably the result of: A Hyperammonemia zz Anterior vermian atrophy

C Central pontine myelinolysis D Congestive heart failure E Korsakoff's syndrome Question 51 The most common location for an intracranial schwannoma (neurilemmoma) is which of the following cranial nerves: A III zzB VIII / at the cerebellopontine angle

C IX D V E XII Question 52 A 45-year-old male undergoes psychiatric evaluation for recent psychotic behaviorHuntington dz. During the interview, he exhibits twitching movements of his arms. Which of the following findings is LEAST consistent with the probable underlying disease process: A Family history of a similar disorder B Mild atrophy of the caudate on CT scan

C Progression of the disease zzD Improvement with L-dopa medication/ Parkinsons dz E Loss of GABA neurotransmitter Question 53 Central pontine myelinolysis (CPM) is most often a finding in association with: A Multiple sclerosis zzB Chronic alcoholism C Infarction D Arnold-Chiari malformation E Guillain-Barre syndrome Question 54 Six weeks after a camping trip to Flaming Gorge, a 36-year-old male notices **paresthesias around the site of a raccoon/bat/rabid animal bite he incurred on the trip. **Convulsions, then **flaccid paralysis and **coma, ensue. What pathologic finding is probably present? A Spinal cord anterior horn neuronal loss with gliosis B Chronic meningoencephalitis zzC Hippocampal neuronal eosinophilic intracytoplasmic inclusions

negri body of rabies virus from the raccoon

D Microglial nodules in cerebral cortex E Spongiform encephalopathy Question 55 An increased cerebrospinal fluid protein with a normal cell count and a normal glucose is most indicative of: zzA Glioblastoma multiforme

GBM cross at the corpus collosum and it seeds through the CSF.

B C D E

Tuberculous meningitis Wernicke's disease Herpes simplex encephalitis Intraparenchymal brain hemorrhage

Question 56 Cerebral cortex that histologically shows numerous senile plaques is most consistent with which of the following histories: A A 48-year-old male with choreiform movements B A 30-year-old female with sudden loss of consciousness C A 44-year-old male with progressive muscular weakness zzD A 40-year-old female with Down's syndrome / extra dose of Chr 21,19,14 ?//Alzheimers dz E A 2-year-old boy with blindness and decreased neurologic function Question 57 A 69-year-old male with a history of a remote myocardial infarction is found at autopsy to have a 4-cm diameter area of softening in the region of the left middle cerebral artery distribution. This is most consistent with: A Vasculitis zzB Arterial embolization

some form of infract

C Venous thrombosis D Hypertension E Mycotic aneurysm Question 58 A 50-year-old female has had right-sided headaches for 5 years, but recently noted mild weakness in her right hand. A CT scan shows a [well-circumscribed lateral mass] compressing the right hemisphere at the frontal-parietal junction. This is probably a: A Medulloblastoma B Metastatic carcinoma C Schwannoma D Glioblastoma multiforme zzE Meningioma // contrality and focal neurological effects.

these are slow growing benign tumors that normally are attached to the dura it becomes symptomatic when it reaches large size, originate from meningothelial cells of the arachnoid. Mc site are the parasagittal aspect of the brain convexity,dura of the lateral convexity,wing of the sphenoid ,olfactory grove and the sella turcica, foramen magnum. Question 59 A 65-year-old male has been healthy all his life until a sudden seizure. Neurologic exam reveals no focal abnormalities. A CT scan reveals a poorly demarcated large mass with central necrosis in the right frontal lobe. The most likely diagnosis is:

zzA Glioblastoma multiforme /focal 1]necrosis and 2]hemorrhagic in apart of the cerebral H// increased protein but glucose and cell count are Normal. B Medulloblastoma C Low grade astrocytoma D Meningioma E Choroid plexus tumor Question 60 True statements regarding intracranial berry aneurysms include all of the following EXCEPT: zzA They are present at birth/ thought they are some times called congenital.. B Subarachnoid hemorrhage could result from rupture. C They can be associated with dominant polycystic kidney disease. D Rupture is probably not associated with systemic hypertension. E Intraparenchymal hemorrhage could result from rupture. Question 61 A 52-year-old male with chronic respiratory difficulty dies from bronchopneumonia. At autopsy, the anterior spinal nerve roots are atrophic, and spinal cord anterior horns show neuronal loss with gliosis. These findings are most consistent with: A Gullain-Barre syndrome zzB Poliomyelitis C Rabies infection D Botulism E Amyotrophic lateral sclerosis Question 62 A 78-year-old male who suffers ischemic injury with cerebral infarction most likely has which of the following histopathologic findings: A Gangrenous necrosis zzB Liquefactive necrosis /./

C Coagulative necrosis D Caseous necrosis E Fat necrosis Question 63 During a fight at the Beacon Club in Casper, Wyoming, a patron is knocked backwards off a barstool and lands on the back of his head. Which of the following pathologic findings is most likely to be present as a consequence of this injury: A Occipital lobe contusions [ contusion and laceration = direct injury]. B Subarachnoid hemorrhage xxC Inferior frontal lobe contusions //coup injury( direct injury) and countercoup( injury opposite the site of the direct blow due to sudden decerleration. D Anterior pituitary necrosis E Skull fracture with epidural hematoma Question 64 The presence of a neural tube defect is suggested most strongly by which of the following findings: A Decreased maternal serum alpha- fetoprotein B Microcephaly C Hydranencephaly zzD Spina bifida E Polyhydramnios Question 65 1] Progressive spastic paraparesis, 2]optic nerve atrophy, 3]sensory ataxia, and marked 4] paresthesias of the legs are most characteristic of a 44-year-old male with: A Chronic alcoholism B Down's syndrome

xxxC Pernicious anemia/ lack of IF due to parietal cell deficiency by AI Ab/megaloblastic anemia w/hypersegmented WBC. PA is assd with CNS and neurologic changes. The anemia can be corrected w folic acid but the neurologic changes needs vitamin B12/colabolamin D Lead poisoning E Diabetes mellitus, type I Question 66 A 54-year-old female has a lumbar puncture performed. The cerebrospinal fluid (CSF) opening pressure is 220 mm H2O, the CSF protein 60 mg/dl, and the CSF glucose 75 mg/dl (serum glucose 105 mg/dl). Biopsy of a 3-cm right parietal mass reveals 1]gliosis and 2]fibrosis with necrosis, 3]neutrophils, and4] lymphocytes. These findings suggest: A Glioblastoma multiforme B Herpes simplex type II encephalitis C Vascular malformation D Subacute infarction zzE Cerebral abscess

Question 67 A 38-year-old female has abrupt onset of dizziness with nausea and vomiting. These symptoms disappear in several days, and she has only mild vertigo for several more days. She probably has: A Gullain-Barre syndrome B Cerebral edema C A schwannoma D A cerebral abscess xxE Vestibulitis Question 68

A 35-year-old female has vasospasm of cerebral arteries. This is most likely to occur with: a complication of ruptured berry aneurysm A Acute pneumococcal meningitis B Metastatic breast carcinoma zzC Ruptured berry aneurysm

D Hypertension E Blunt trauma with contracoup injury Question 69 Which of the following intracranial neoplasms has the best prognosis following surgery: zzA Schwannoma B Glioblastoma multiforme C Astrocytoma D Medulloblastoma E Solitary metastasis Question 70 Stereotactic brain biopsy of one of several periventricular 1 to 3 cm masses yields tissue with a ***monoclonal proliferation of immunoblasts. Which of the following histories is most compatible with these findings: A A 5-year-old child with leukemia B A 30-year-old female with prior history of radiation therapy C A 40-year-old male with Down's syndrome zzD A 35-year-old male with HIV infection //fusion of microphages forms a multinucleated giant cells E A 15-year-old female with viral encephalitis Question 71 A 50-year-old Vietnam veteran had a history of 1] paresthesias, 2] difficulty moving one or more extremities, 3] loss of sensation, and 4]ataxia over 22 years. These problems

would come and go, but he eventually developed paraplegia and incontinence. Which of the following findings best explains his history: A Parasaggittal meningioma zzB Scattered plaques of demyelination / multiple sclerosis C Shrapnel in spinal cord D Wernicke's disease E Progressive multifocal leuko- encephalopathy Question 72 Which of the following statements concerning an epidural hematoma is most appropriate: zzA It is accompanied by a skull fracture. ConvEx = epidural

due to a fracture of the skull and the tear of the middle menengial artery. Lucid periods and sudden coma and death.

B C D E

The bleeding is of venous origin. Onset of symptoms is delayed following vascular rupture. A fluctuating level of consciousness is evidenced by the patient. It can occur as a result of rupture of a mycotic aneuysm.

Question 73 Wallerian degeneration of peripheral nerve can demonstrate all of the following features EXCEPT: A Appearance following severe trauma or infarction B Axonal and myelin sheath degeneration occurs distal to the site of injury

C Regeneration can follow the nerve injury D Can occur when the neuron that governs an axon dies

zzE Can be seen with Guillain-Barr syndrome Question 74 An elderly nursing home patient has had a history of several falls, but has never lost consciousness and has remained stable. She develops increasing mental confusion associated with a mild right hemiparesis over several weeks. A CT scan demonstrates left hemispheric compression. These findings are most consistent with: A Epidural hematoma B Glioblastoma multiforme C Hypertensive hemorrhage D Cerebral abscess zzE Chronic subdural hematoma

Normally these bridging veins are slow bleeding and self limiting. /// CT Question 75 Which of the following conditions is LEAST likely to cause an increase in cerebrospinal fluid pressure in the ventricular system with resultant hydrocephalus: A Tuberculous meningitis B Ependymoma of 4th ventricle C Herpes simplex encephalitis ***D Cerebellopontine angle schwannoma/bilateral acustic neuroma E Choroid plexus papilloma

Question 76 An intraparenchymal hemorrhagic lesion of the brain is LEAST likely to develop as a result of: A Hypertension B Herpes simplex encephalitis C Vascular malformation zzD Cysticercosis/ need egg of pork tape worm E Disseminated aspergillosis Question 77 A 45-year-old female presents with the acute onset of left hemiparesis and facial droop. A cerebral angiogram demonstrates occlusion of the right middle cerebral artery. The most common source for an embolus that could produce these acute symptoms is: zzA Left atrium B Carotid bifurcation C Saphenous vein D Tricuspid valve E Aortic arch
Question 78

Durt hemorrhages of the midbrain and/or the pons following severe uncal herniation would be LEAST likely to occur with: zzA Alzheimer's disease B Glioblastoma multiforme C Hypertensive hemorrhage D A blow to the head E Meningioma F Edema Question 79 Which of the following findings is NOT characteristic for human degenerative neurologic diseases: AD, HD, PD A Progessive neurologic deficits over many years B Loss of specific neuronal groups C Lack of specific and/or curative therapies D Specific patterns of inheritance zzE Mass effect with acute symptoms /of tumors Question 80

A 46 year old male with a history of intravenous drug use is found to be HIV positive with a CD4 lymphocyte count of 189/microliter. He is admitted with increasing headache over a day along with fever. Physical examination reveals nuchal rigidity. Which of the following infectious agents is most likely to account for these findings: A J-C strain of papovavirus B Mycobacterium tuberculosis zzC Staphylococcus aureusxx D Herpes simplex virus E Toxoplasma gondii Question 81 A 79 year old retired banker has had a long history of transient ischemic attacks. For the past few years, his wife is saying with greater frequency, "Now what did I tell you just a few minutes ago?" However, he can recognize all family members and can talk at length about events of the past. He can still feed and clothe himself. Which of the following pathologic findings best explains this situation: Xx A Loss of neurons in the hippocampi //lost short term memory. Alzeihmas dz ? B Numerous cortical senile plaques C Metastatic carcinoma to cerebrum D Cerebral vasculitis E Head trauma Questions 82 and 83: Click on the checkbox first, then the lettered item: A (82) A serum specimen from the mother of a fetus with a neural tube defect. E (83) A patient with AIDS with progressive neurologic decline and a CT scan showing multifocal white matter lesions. A B C D E Elevated serum alpha-fetoprotein Oligoclonal bands in CSF Herpes simplex virus Amyloid angiopathy JC papovavirus// cause PML

Questions 84 and 85: Click on the checkbox first, then the lettered item: C (84) Parkinson's disease./loss of DA neurons in the Substantia Nigra w/ melanine loss/decrease facial expression, festinating gait, pill rolling tremor, BRADICARDIA, +/dementia.

A (85) Huntington's disease//choreoathetosis, affective disorder (suicidal) & dementia A B C D E Neuronal loss in the caudate nucleus Anterior horn cell loss Lewy bodies Amyloid angiopathy Hexosaminidase A deficiency

Questions 86 and 87: Click on the checkbox first, then the lettered item: D (86) Human immunodeficiency virus. A (87) Neisseria meningitidis. A B C D E Neutrophilic exudate Perivascular lymphocytes Granulomas Microglial nodules with macrophages Cysts in the cerebrum

Questions 88 and 89: Click on the checkbox first, then the lettered item: B (88) Tay-Sachs disease is associated with a decrease in this substance. D (89) Metachromatic leukodystrophy occurs with a deficiency of this substance. A B C D E Sphingomyelinase Hexosaminidase A Glucocerebrosidase Aryl-sulfatase A Alpha-L-iduronidase

Questions 90 and 91: Click on the checkbox first, then the lettered item: C (90) Alzheimer's disease. D (91) Huntington's chorea. A Autosomal recessive B X-linked recessive

C Trisomy 21 D Autosomal dominant E Chromosome 13 Questions 92 and 93: Click on the checkbox first, then the lettered item: D (92) A 50-year-old male is diagnosed with a rapidly growing left hemispheric glioma. A A B C D E (93) Hypertensive arteriolosclerosis is present in a 70-year-old male. Basal ganglia hemorrhage Subdural hematoma Subarachnoid hemorrhage Pontine Durt hemorrhage Epidural hematoma

Questions 94 and 95: Click on the checkbox first, then the lettered item: E (94) Usually located in the ** 4th ventricle in childhood or ** in spinal cord in adults. C (95) Often presents with hydrocephalus, more common in children, and is very well differentiated. A B C D E Astrocytoma Meningioma Choroid plexus papilloma Oligodendroglioma Ependymoma

Questions 96 and 97: Click on the checkbox first, then the lettered item: C (96) Encephalopathy// lead poisoning B (97) Visual loss/ methyl alcohol poisoning/ methanol / wood alcohol/moonshine A B C D E Mercury (organic) poisoning Methyl alcohol poisoning Lead (inorganic) poisoning Thiamine deficiency Isoniazid therapy

Questions 98 and 99: Click on the checkbox first, then the lettered item: A (98) A 23 year old primagravida delivers a stillborn at 34 weeks gestation with marked 1] hydrops fetalis and 2] organomegaly. B (99) A 25 year old female has acute onset of confusion followed by a seizure. A CT scan of the head reveals a lesion in the left temporal lobe. A B C D E Cytomegalovirus Herpes simplex virus /tropism for the temporal lobes Human immunodeficiency virus Epstein-Barr virus JC Papovavirus

Question 100 A 14-year-old boy is brought to the emergency room following a skateboarding accident in which he hit his head against a concrete wall. He was initially unconscious but then "came to". However, in the emergency room, he is comatose, and skull radiograph reveals a linear fracture of the temporal-parietal region on the left. The best explanation for these findings is: A Acute subdural hematoma xxB Epidural hematoma/ with licid periods and coma and death C Ruptured berry aneurysm D Cerebral edema with uncal herniation E Contusion of frontal lobes Question 101 Following a mild upper respiratory flu-like illness, a 47-year-old male develops a rapidly ascending paralysis. A week later he is hospitalized and requires intubation with mechanical ventilation. Lumbar puncture yields clear CSF under normal pressure with a slightly elevated protein, but no red blood cells and only 3 mononuclear cells. He gradually improves over the next couple of weeks. He most likely has: A Multiple sclerosis B Amyotrophic lateral sclerosis C Huntington's disease xxD Guillain-Barr syndrome E Werdnig-Hoffman disease

Question 102 A 52-year-old male from Rock Springs has headaches and difficulty concentrating for several months. He then begins to exhibit odd behavior, including shooting at fence posts in his back yard, which the neighbors find disconcerting. He suffers a seizure, and is admitted to the hospital, where a CT scan reveals a large mass with extensive necrosis in the left cerebral hemisphere extending across corpus callosum to the right hemisphere. The most likely diagnosis is: A Meningioma xxB Glioblastoma multiforme . Grade 4 astrocytoma C Medulloblastoma D Metastatic adenocarcinoma E Craniopharyngioma [ remnant of the Rathkes poutch].