ALL Webpath and Quizzes for Exam 3 Combined 2023
with complete solution
A 25-year-old man falls while skateboarding and strikes the left side of his head
against a concrete retaining wall. On physical examination only a minor scalp
abrasion is present at the site of the impact, with minimal bleeding that stops in 3
minutes. He is initially alert following this accident, but then became unconscious
30 minutes later. A head CT scan reveals a convex, lens-shaped area of
hemorrhage centered over the left parietal region. These events are most likely to
be associated with damage to which of the following parts of the intracranial
vasculature?
A Bridging veins
B Cavernous sinus
C Great vein of Galen
D Inferior cerebellar artery
E Middle meningeal artery
F Ophthalmic branch of external carotid artery
E Middle meningeal artery
A 70-year-old man has a 2 day history of worsening generalized headache and
increasing obtundation. He now complains of stiffness in his neck. On physical
examination vital signs include T 38.7°C, pulse 85/minute, respirations 23/minute,
and blood pressure 130/85 mm Hg. A CBC reveals a WBC count of
16,850/microliter. Serum electrolytes include a glucose of 88 mg/dL. A lumbar
puncture yields cloudy cerebrospinal fluid with a glucose of 32 mg/dL, protein
146 mg/dL, and cell count of 3800 WBCs (95% PMNs and 5 % mononuclears) and
122 RBCs. He receives antibiotic therapy and improves. Which of the following
long-term complications is most likely to develop from this man's current
disease?
A Cerebral infarction
B Cerebellar tonsillar herniation
C Encephalitis
D Hydrocephalus
E Subdural hematoma
D Hydrocephalus
,An enterprising home distiller is using a barley mash to produce his own alcohol.
He drinks the product and over the next day develops headache and difficulty
walking. He now has difficulty with vision. On funduscopic examination there is
optic disk hyperemia. He is disoriented and has difficulty answering questions.
Which of the following is most likely responsible for the toxic effects he is
experiencing?
A Mercury
B Formic acid
C Lead
D Organophosphate
E Oxalic acid
F Acetaldehyde
B Formic acid
A 73-year-old man is undergoing radical prostatectomy for prostatic
adenocarcinoma. During this procedure the anesthesiologist reports a drop in
blood pressure with hypotension that persists for 30 minutes despite intervention
with pressor agents. Which of the following pathologic lesions is most likely to
occur in his brain as a consequence of this prolonged hypotensive episode?
A Hydranencephaly
B Linear parasagittal infarction
C Lacunar infarcts of basal ganglia
D Parietal lobe hemorrhagic infarction
E Anterior pituitary necrosis
B Linear parasagittal infarction
A 28-year-old man undergoes induction chemotherapy for acute myelogenous
leukemia. A week later he becomes severely pancytopenic, with WBC count of
1320/microliter, Hgb 7.9 g/dL, and platelet count 72,000/microliter. Head CT scan
shows a right parietal hemorrhage. MR imaging and angiography reveals a right
middle cerebral arterial thrombosis with right parietal hemorrhagic infarction.
Which of the following infectious agents is most likely to cause these findings?
A Herpes simplex virus
B Toxoplasma gondii
,C Human immunodeficiency virus
D Cytomegalovirus
E Aspergillus flavus
E Aspergillus flavus
A 27-year-old G2 P1 woman gives birth following an uncomplicated pregnancy at
29 weeks gestation to a girl infant. Her prior pregnancy resulted in a normal term
birth. She continued to smoke 1 pack of cigarettes per day during the current
pregnancy. Following the delivery, the baby receives surfactant therapy and does
not develop respiratory distress from hyaline membrane disease. However, the
infant has a seizure during the next day of life. Which of the following conditions
did this baby most likely develop?
A Intraventricular hemorrhage
B Intracerebellar hemorrhage
C Subdural hematoma
D Subgaleal hemorrhage
E Epidural hematoma
A Intraventricular hemorrhage
Following an episode of severe head trauma incurred in a motorcycle accident,
an 18-year-old woman is noted to have decerebrate posturing. Funduscopic
examination reveals marked bilateral papilledema. A CT scan of the head reveals
marked diffuse cerebral edema from an increase in sodium and water content.
There is effacement of lateral ventricles. This edema is most likely to be severest
in which of the following parts of the brain?
A Gray matter
B Meninges
C White matter
D Dura
E Ependyma
C White matter
A 32-year-old woman has noted problems with writing for the past month. She
has difficulty controlling her hand movements, and the writing is nearly illegible.
On examination she has decreased strength in her right upper extremity and
decreased light touch sensation over her left lower extremity. She has no
decrease in mentation, and there is no reported seizure activity. A lumbar
, puncture is performed, and the CSF contains elevated levels of IgG, some
mononuclear cells, and oligoclonal bands on gel electrophoresis. Which of the
following pathologic findings in the CNS is she most likely to have?
A Loss of pigmented neurons in the substantia nigra
B Perivascular lymphocytes with demyelinated axons in white matter
C Increased neurofibrillary tangles and neuritic plaques in the neocortex
D Periventricular lymphoid aggregates with cells marking with CD19
E Foci of multinucleated cells and macrophages in grey and white matter
F Gliosis with atrophy of caudate and putamen
B Perivascular lymphocytes with demyelinated axons in white matter
A 23-year-old primigravida has noted minimal fetal movement. A fetal ultrasound
is performed at 17 weeks gestation and shows an intact fetal cranial vault, mild
ventriculomegaly, intact cerebral hemispheres, a 'lemon sign' (due to flattened
frontal bones), a 'banana sign' (due to effacement of the cisterna magna), a
normal foramen magnum, and head measurements that are small for gestational
age. The maternal serum alpha-fetoprotein is increased. Which of the following
fetal congenital abnormalities is most likely to be present in this case?
A Meningocele
B Encephalocele
C Arnold-Chiari II malformation
D Lissencephaly
E Alobar holoprosencephaly
A Meningocele
A 69-year-old woman has exhibited fluctuating cognitive function, lapses in
attention, excessive daytime sleepiness, and periods of disorganized speech over
the past 3 years. In the past month she has had visual hallucinations and memory
loss. MR imaging of her brain shows minimal cortical and hippocampal atrophy.
A SPECT dopamine transporter scan is abnormal. Which of the following
movement problems is she most likely to manifest?
A Choreoathetosis
B Dysdiadochokinesia
C Hemiballismus
with complete solution
A 25-year-old man falls while skateboarding and strikes the left side of his head
against a concrete retaining wall. On physical examination only a minor scalp
abrasion is present at the site of the impact, with minimal bleeding that stops in 3
minutes. He is initially alert following this accident, but then became unconscious
30 minutes later. A head CT scan reveals a convex, lens-shaped area of
hemorrhage centered over the left parietal region. These events are most likely to
be associated with damage to which of the following parts of the intracranial
vasculature?
A Bridging veins
B Cavernous sinus
C Great vein of Galen
D Inferior cerebellar artery
E Middle meningeal artery
F Ophthalmic branch of external carotid artery
E Middle meningeal artery
A 70-year-old man has a 2 day history of worsening generalized headache and
increasing obtundation. He now complains of stiffness in his neck. On physical
examination vital signs include T 38.7°C, pulse 85/minute, respirations 23/minute,
and blood pressure 130/85 mm Hg. A CBC reveals a WBC count of
16,850/microliter. Serum electrolytes include a glucose of 88 mg/dL. A lumbar
puncture yields cloudy cerebrospinal fluid with a glucose of 32 mg/dL, protein
146 mg/dL, and cell count of 3800 WBCs (95% PMNs and 5 % mononuclears) and
122 RBCs. He receives antibiotic therapy and improves. Which of the following
long-term complications is most likely to develop from this man's current
disease?
A Cerebral infarction
B Cerebellar tonsillar herniation
C Encephalitis
D Hydrocephalus
E Subdural hematoma
D Hydrocephalus
,An enterprising home distiller is using a barley mash to produce his own alcohol.
He drinks the product and over the next day develops headache and difficulty
walking. He now has difficulty with vision. On funduscopic examination there is
optic disk hyperemia. He is disoriented and has difficulty answering questions.
Which of the following is most likely responsible for the toxic effects he is
experiencing?
A Mercury
B Formic acid
C Lead
D Organophosphate
E Oxalic acid
F Acetaldehyde
B Formic acid
A 73-year-old man is undergoing radical prostatectomy for prostatic
adenocarcinoma. During this procedure the anesthesiologist reports a drop in
blood pressure with hypotension that persists for 30 minutes despite intervention
with pressor agents. Which of the following pathologic lesions is most likely to
occur in his brain as a consequence of this prolonged hypotensive episode?
A Hydranencephaly
B Linear parasagittal infarction
C Lacunar infarcts of basal ganglia
D Parietal lobe hemorrhagic infarction
E Anterior pituitary necrosis
B Linear parasagittal infarction
A 28-year-old man undergoes induction chemotherapy for acute myelogenous
leukemia. A week later he becomes severely pancytopenic, with WBC count of
1320/microliter, Hgb 7.9 g/dL, and platelet count 72,000/microliter. Head CT scan
shows a right parietal hemorrhage. MR imaging and angiography reveals a right
middle cerebral arterial thrombosis with right parietal hemorrhagic infarction.
Which of the following infectious agents is most likely to cause these findings?
A Herpes simplex virus
B Toxoplasma gondii
,C Human immunodeficiency virus
D Cytomegalovirus
E Aspergillus flavus
E Aspergillus flavus
A 27-year-old G2 P1 woman gives birth following an uncomplicated pregnancy at
29 weeks gestation to a girl infant. Her prior pregnancy resulted in a normal term
birth. She continued to smoke 1 pack of cigarettes per day during the current
pregnancy. Following the delivery, the baby receives surfactant therapy and does
not develop respiratory distress from hyaline membrane disease. However, the
infant has a seizure during the next day of life. Which of the following conditions
did this baby most likely develop?
A Intraventricular hemorrhage
B Intracerebellar hemorrhage
C Subdural hematoma
D Subgaleal hemorrhage
E Epidural hematoma
A Intraventricular hemorrhage
Following an episode of severe head trauma incurred in a motorcycle accident,
an 18-year-old woman is noted to have decerebrate posturing. Funduscopic
examination reveals marked bilateral papilledema. A CT scan of the head reveals
marked diffuse cerebral edema from an increase in sodium and water content.
There is effacement of lateral ventricles. This edema is most likely to be severest
in which of the following parts of the brain?
A Gray matter
B Meninges
C White matter
D Dura
E Ependyma
C White matter
A 32-year-old woman has noted problems with writing for the past month. She
has difficulty controlling her hand movements, and the writing is nearly illegible.
On examination she has decreased strength in her right upper extremity and
decreased light touch sensation over her left lower extremity. She has no
decrease in mentation, and there is no reported seizure activity. A lumbar
, puncture is performed, and the CSF contains elevated levels of IgG, some
mononuclear cells, and oligoclonal bands on gel electrophoresis. Which of the
following pathologic findings in the CNS is she most likely to have?
A Loss of pigmented neurons in the substantia nigra
B Perivascular lymphocytes with demyelinated axons in white matter
C Increased neurofibrillary tangles and neuritic plaques in the neocortex
D Periventricular lymphoid aggregates with cells marking with CD19
E Foci of multinucleated cells and macrophages in grey and white matter
F Gliosis with atrophy of caudate and putamen
B Perivascular lymphocytes with demyelinated axons in white matter
A 23-year-old primigravida has noted minimal fetal movement. A fetal ultrasound
is performed at 17 weeks gestation and shows an intact fetal cranial vault, mild
ventriculomegaly, intact cerebral hemispheres, a 'lemon sign' (due to flattened
frontal bones), a 'banana sign' (due to effacement of the cisterna magna), a
normal foramen magnum, and head measurements that are small for gestational
age. The maternal serum alpha-fetoprotein is increased. Which of the following
fetal congenital abnormalities is most likely to be present in this case?
A Meningocele
B Encephalocele
C Arnold-Chiari II malformation
D Lissencephaly
E Alobar holoprosencephaly
A Meningocele
A 69-year-old woman has exhibited fluctuating cognitive function, lapses in
attention, excessive daytime sleepiness, and periods of disorganized speech over
the past 3 years. In the past month she has had visual hallucinations and memory
loss. MR imaging of her brain shows minimal cortical and hippocampal atrophy.
A SPECT dopamine transporter scan is abnormal. Which of the following
movement problems is she most likely to manifest?
A Choreoathetosis
B Dysdiadochokinesia
C Hemiballismus
