M2 CNS Summative Quiz

A 65-year-old man comes to the physician because of experiencing episodes of double vision. He says that double vision is intermittent and has been going on for 3 months. The patient is wondering if he has to change his prescription glasses. The patient has not had any headaches or dizziness. Physical examination shows that the patient experiences diplopia, and when he is asked to turn his right eye inward toward his nose and look down, he is able to look inward but not down. Which nerve is most likely involved?

A 44-year-old woman comes to the physician for follow-up examination. She is being treated for Raynaud disease and systemic lupus erythematosus. Her medication regimen contains a sympathetic blocking drug that is administered in high doses. Which of the following conditions will most likely be expected to occur as an adverse effect of the drug?

A 32-year-old woman is brought to the emergency department because of a sudden onset of headaches and dizziness. Physical examination shows that the patient has partial ptosis, miosis, and anhidrosis on the right side of her face. She says this has never happened before. It was her sister that noticed her eyelid was drooping. Which of the following muscles is most likely paralyzed to cause her ptosis?

A 32-year-old man is brought to the emergency department because of difficulties with his vision. Physical examination shows a loss of the lateral halves of the fields of vision in both eyes (bitemporal hemianopia). An MRI of the head shows a tumor of the adenohypophysis. Which of the following structures was most likely compressed by the tumor?

A 57-year-old man is brought to the emergency department because of dizziness and a severe headache. Physical examination shows the patient’s eyeball is fixed in an abducted position, slightly depressed, the pupil is dilated and the upper lid is droopy. When the patient is asked to move the pupil toward the nose, the pupil rotates medially. Consensual corneal reflexes are normal. A CT scan of the head shows a tumor in the superior orbital fissure. Which of the following nerves is most likely affected? 

A 55-year-old woman comes to the physician because of deteriorating vision. Ophthalmologic examination tests the globe, the retina, and the cornea of each eye and all extraocular eye movements are observed to ensure full range of motion, smoothness of movements, and synchronicity bilaterally. Which of the following nerves must be functioning properly if the patient is able to abduct the eye without difficulty and without upward or downward deviation? 

A 12-year-old boy is brought to the emergency department because of fever and fatigue. Physical examination shows neck stiffness and neck tenderness with passive movement. The patient was diagnosed with meningitis and a lumbar puncture is performed to determine the etiology of infection. However, lumbar puncture should not be performed when CSF pressure is elevated. Which of the following conditions would most likely indicate an elevated CSF pressure?

A 65-year-old woman is brought to the emergency department after being diagnosed with cavernous sinus thrombosis. The patient has headaches but is otherwise stable. A CT scan of the head shows an aneurysm of the internal carotid artery within the cavernous sinus. Which of the following will most likely be present during physical examination if nerve compression was suspected within the cavernous sinus? 

A 36-year-old woman is brought to the emergency department after being struck in the left orbital region by a ball. Physical examination of the left eye shows the eye is unable to abduct. An x-ray of the head shows a blow-out fracture of the medial wall of the orbit. Which of the following muscles is most likely injured or trapped? 

A 54-year-old woman is brought to the emergency department because of a severe headache, nausea, and vomiting. Physical examination shows that she is unconscious. When she regains consciousness, her right eye is directed laterally and inferiorly. There is also complete ptosis of her upper eyelid and pupillary dilation of the affected eye. An MRI of the head shows a tumor in her brain producing a transtentorial herniation. Which of the following lobes of the brain is most likely affected by the tumor? 

A 55-year-old woman is brought to the emergency department by her husband after she was found unconscious in their home. She has a history of poorly controlled hypertension. Her temperature is 37.5°C (99.5°F), pulse is 90/min, respirations are 16/min, and blood pressure is 175/100 mm Hg. Physical examination shows ptosis of the right eye and right pupillary mydriasis. The right eye is also deviated inferolaterally. A non-contrast CT scan shows a subarachnoid hemorrhage. Angiography is most likely to show a hematoma compressing which of the following structure structures? 

An 88-year-old man comes to the physician because of blurry vision and headache for the past 6 months. Physical examination shows an inability to abduct his right eye and ipsilateral absence of the corneal reflex. A CT scan of the head shows a dural mass. A growth located in which of the following structures of the skull is most likely responsible for the symptoms of this patient?