07-16-2016, 07:47 PM
33) A previously healthy 47-year-old man is brought to the physician because of a 2-week history of progressive weakness. He says that during this period, his feet “flop” while walking, and he trips when walking up stairs. During the past week, he has had difficulty standing up from low chairs and opening jars. He has not had pain or tingling. He has had constipation but no changes in bladder or sexual function. He has not had any recent infections or vaccinations. He takes no medications. He has smoked one pack of cigarettes daily for 20 years. He drinks three to four beers daily; for the past 6 weeks he has been drinking home-distilled whiskey. Examination shows atrophy of the intrinsic muscles of the hands and feet. Muscle strength is 4/5 in the wrist and finger extensors, interosseous, iliopsoas, and hamstring muscles and 3/5 in the anterior tibialis, peronei, and posterior tibialis muscles. Deep tendon reflexes are 1+ diffusely. Babinski sign is absent. Sensory examination shows no abnormalities. Laboratory studies show microcytic anemia and hyperuricemia. Which of the following is the most likely cause of this patient’s neurologic symptoms?
A) Acute intermittent porphyria (wrong answer)
B) Alcohol abuse
C) Guillian-Barre syndrome
D) Hepatolenticular degeneration (Wilson disease)
E) Lead poisoning
45) An 18-year-old man is brought to the emergency department 1 hour after he fell 25 feet. On examination, he is paraplegic and has urinary incontinence. Examination of the lower extremities shows absent reflexes and flaccid tone. Babinski sign is present bilaterally. X-rays of the spine show a fracture dislocation of T10. Which of the following is the most likely explanation for this patient’s urinary incontinence?
A) Compression of the conus medullaris
B) Compression of the S3—4 nerve roots (wrong answer)
C) Compression of the T10—11 nerve roots
D) Compression of the thoracic spinal cord
E) Rupture of the bladder neck
46) A 77-year-old woman is brought to the physician by her husband because of a 3-day history of visual difficulties. He says she seems a little "off balance." She agreed to come in after denting the car on the left side while parking it in the garage. She has not had any headaches or noticed any difficulty using either side of her body. She has not fallen recently. She has a 2-year history of atrial fibrillation treated with aspirin. She is sitting comfortably in a chair. Her temperature is 37°C (98.6°F), pulse is 95/min, respirations are 22/min, and blood pressure is 110/80 mm Hg. Examination shows a left homonymous hemianopia. Muscle strength, muscle tone, and sensation are intact bilaterally. Speech is normal. She is alert and oriented to person, place, and time. When asked to read, she only reads the words on the right side of the page. A CT scan of the head is most likely to show an infarct in the territory of which of the following cerebral arteries?
A) Left anterior
B) Left middle
C) Left posterior
D) Right anterior wrong
E) Right middle (wrong answer)
F) Right posterior
Whats the answer guys? And please give some explanation too..thanks!!
A) Acute intermittent porphyria (wrong answer)
B) Alcohol abuse
C) Guillian-Barre syndrome
D) Hepatolenticular degeneration (Wilson disease)
E) Lead poisoning
45) An 18-year-old man is brought to the emergency department 1 hour after he fell 25 feet. On examination, he is paraplegic and has urinary incontinence. Examination of the lower extremities shows absent reflexes and flaccid tone. Babinski sign is present bilaterally. X-rays of the spine show a fracture dislocation of T10. Which of the following is the most likely explanation for this patient’s urinary incontinence?
A) Compression of the conus medullaris
B) Compression of the S3—4 nerve roots (wrong answer)
C) Compression of the T10—11 nerve roots
D) Compression of the thoracic spinal cord
E) Rupture of the bladder neck
46) A 77-year-old woman is brought to the physician by her husband because of a 3-day history of visual difficulties. He says she seems a little "off balance." She agreed to come in after denting the car on the left side while parking it in the garage. She has not had any headaches or noticed any difficulty using either side of her body. She has not fallen recently. She has a 2-year history of atrial fibrillation treated with aspirin. She is sitting comfortably in a chair. Her temperature is 37°C (98.6°F), pulse is 95/min, respirations are 22/min, and blood pressure is 110/80 mm Hg. Examination shows a left homonymous hemianopia. Muscle strength, muscle tone, and sensation are intact bilaterally. Speech is normal. She is alert and oriented to person, place, and time. When asked to read, she only reads the words on the right side of the page. A CT scan of the head is most likely to show an infarct in the territory of which of the following cerebral arteries?
A) Left anterior
B) Left middle
C) Left posterior
D) Right anterior wrong
E) Right middle (wrong answer)
F) Right posterior
Whats the answer guys? And please give some explanation too..thanks!!