MCQ Book Questions

Q60902. The patient described in Question 28 persists in a vegeta- tive coma for several months and then expires. A section of the temporal lobe shows massive proliferation of cells with a star-shaped appearance (shown in the image). Which of the following best accounts for this cellular response to injury?

Q60903. A 10-month-old girl is brought to the emergency room with severe, unremitting watery diarrhea. Her blood pressure is 80 mm Hg systolic, and the pulse is 120 per minute. Which of the following is a potentially lethal complication of systemic dehydration in this patient?

Q60904. A 54-year-old woman dies 48 hours after suffering severe head injuries in an automobile accident. Just before her death, her left pupil becomes fi xed and dilated. An inferior view of the patient’s brain at autopsy is shown in the image. Which of the following was the most likely cause of death?

Q60905. Further examination of the brainstem at autopsy of the patient described in Question 25 would most likely reveal which of the following pathologic fi ndings?

Q60906. A 1-year-old boy presents with a delay in motor development. Progressive muscle weakness and blindness ensue, and the patient dies within a year. The brain at autopsy shows swollen neurons that contain numerous lysosomes fi lled with lipid. Which of the following is the most likely diagnosis?

Q60907. A 59-year-old woman presents with headache and mild fever of 3 days in duration. On physical examination, the patient appears confused and inattentive. On the following day, she is rushed to the emergency room after suffering a generalized seizure. Lumbar puncture shows increased levels of CSF pro- tein, but cultures are negative, and the white cell count is not elevated. PCR analysis of the CSF fl uid shows evidence of her- pes simplex type 1. This infection most likely involves which of the following anatomic regions of the patient’s brain?

Q60908. A 68-year-old obese woman (BMI = 34 kg/m2) suffers a stroke and expires. Histologic examination of the brain at autopsy reveals extensive arteriolar lipohyalinosis and numerous Charcot-Bouchard aneurysms. Which of the fol- lowing best accounts for the pathogenesis of these autopsy fi ndings?

Q60909. A 12-year-old boy is rushed to the emergency room in a coma after falling from an upper story window of his home. MRI shows a subdural hematoma over the left hemisphere. What is the most likely source of intracranial bleeding in this patient?

Q60910. Two months later, the patient described in Question 31 expe- riences increasing headaches and muscle weakness and suffers a tonic-clonic seizure. What is the most likely explanation for this patient’s new clinical presentation?

Q60911. A 5-year-old boy is brought to the emergency room with fever, vomiting, and convulsions. The patient is febrile to 39.5°C (104°F). Physical examination reveals cervical rigid- ity and pain in the neck and knees. Acute infl ammation most likely involves which anatomic region of the patient’s brain?

Q60912. A 32-year-old woman presents with a 2-day history of head- ache, vomiting, and fever. Physical examination reveals cervi- cal rigidity and knee pain with hip fl exion. Lumbar puncture demonstrates an abundance of neutrophils and decreased lev- els of glucose. Which of the following diseases is most likely associated with these clinical laboratory fi ndings?

Q60913. Which of the following is the most likely anatomic location of the ruptured aneurysm in the patient described in Question 41?

Q60914. A 62-year-old man with a history of poorly controlled hyper- tension and diabetes presents with sudden onset of weakness. His blood pressure is 200/115 mm Hg, and his pulse is 80 per minute. An X-ray fi lm of the chest demonstrates cardiomegaly and pulmonary edema. A CT scan of the brain reveals intra- parenchymal hemorrhage. The patient becomes unresponsive and eventually expires. Which of the following was the most likely site for cerebral hemorrhage in this patient?

Q60915. A 42-year-old man with AIDS dementia complex dies of respi- ratory insuffi ciency secondary to Pneumocystis carinii pneumo- nia. Examination of the brain at autopsy reveals mild cerebral atrophy, with dilation of the lateral ventricles. Which of the following best explains the pathogenesis of neuronal injury in this patient?

Q60916. A 27-year-old man presents with dementia, weakness, visual loss, and ataxia 1 year after receiving a cadaveric kidney trans- plant. Which of the following is the most likely cause of this patient’s CNS disorder?

Q60917. The patient described in Question 37 is started on antiviral medication but becomes increasingly unresponsive and expires. Examination of affected brain tissue at autopsy would most likely reveal which of the following pathologic fi ndings?

Q60918. A 2-day-old neonate exhibits convulsions. Imaging studies disclose mild hydrocephaly, as well as areas of calcifi cation in periventricular areas and in the brain stem. The neonate is started on broad-spectrum antibiotics but dies within 2 days. Examination of the brain at autopsy reveals pink intranuclear inclusions in Purkinje cells. Which of the following is the most likely etiology of cerebral calcifi cation and convulsions in this neonate?

Q60919. A 48-year-old man with AIDS is admitted to the hospital with a headache, fever of 38.7°C (103°F), and persistent cough. His CD4 cell count is less than 500/mL. Lumbar puncture returns cloudy fl uid, and microscopic examination shows numerous encapsulated microorganisms (shown in the image). Which of the following pathogens is the most likely cause of meningitis in this patient?

Q60920. A 34-year-old intravenous drug abuser presents to the emergency room with a 24-hour history of fever and shak- ing chills. His temperature is 38.7°C (103°F), pulse 92 per minute, and blood pressure 140/80 mm Hg. Cardiac ausculta- tion reveals a harsh systolic murmur. Blood cultures are posi- tive for Staphylococcus aureus. The patient suddenly develops left-sided paralysis. Imaging studies would most likely reveal occlusion of which of the following arteries?

Q60921. A 56-year-old man is rushed to the emergency room after collapsing while shoveling snow. The patient has no pulse on admission but is resuscitated. Laboratory studies show elevated serum levels of cardiac-specifi c proteins, and ECG confi rms a transmural infarct of the left ventricle. The patient expires 2 weeks later of cardiac tamponade. Examination of the patient’s brain at autopsy would most likely reveal necrosis of Purkinje cells and selective loss of neurons in which of the following regions?