QUESTION: 25

A 70-year-old man presents with shuffling gait, tremor, masked facies, and rigidity which have progressed over the last 9 months. Parkinson's disease is diagnosed. In this patient, which neurotransmitter deficiency primarily is responsible for his symptoms?

acetylcholine
epinephrine
norepinephrine
dopamine
cortisol

Answer(s): D

Explanation:

Deficiency of dopamine primarily is responsible for the signs and symptoms of Parkinson's disease.
Specifically, the loss of dopamine from the substantia nigra is thought to be primarily responsible for the akinesia and rigidity. Tremor, akinesia, and rigidity are the classic triad of signs seen in Parkinson's disease. The tremor typically is a resting tremor; often a "pill rolling" tremor is seen in the hand. Well over 90% of patients with Parkinson's disease do have a good initial response to levodopa

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QUESTION: 26

A 70-year-old man presents with shuffling gait, tremor, masked facies, and rigidity which have progressed over the last 9 months. Parkinson's disease is diagnosed. Which of the following is not true about Parkinson's disease?

Over 1 million people in North America have Parkinson's disease.
Mortality is higher in patients with Parkinson's disease when compared to age-matched controls.
The classic triad of major signs of Parkinson's disease is memory loss, rigidity, and akinesia.
The tremor in Parkinson's disease is typically an intention tremor.
Over 90% of patients with Parkinson's disease have a good initial response tolevodopa.

Answer(s): D

Explanation:

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QUESTION: 27

A 73-year-old man has been experiencing increasing drowsiness and incoherence. He has a history of arrhythmias and has fallen twice in the past 2 weeks. There are no focal deficits on neurologic examination. Acontrast CT scan of the head is shown in the figure below. Which of the following is the treatment of choice?

parenteral antibiotics
antifungal therapy
neurosurgical evacuation of the clot
observation and a repeat CT scan in 1 month
fibrinolytic therapy

Answer(s): C

Explanation:

The CT scan shown in Figure demonstrates a smooth, biconvex lens-shaped mass in the periphery of the right temporoparietal region. This picture is characteristic of a subdural hematoma that is a result of laceration of veins bridging the subdural space. Unlike an epidural hematoma, which expands quickly and progresses rapidly to coma, a subdural hematoma is initially limited in size by increased intracranial pressure and expands slowly. Symptoms may follow the inciting trauma by several weeks. Altered mental status is often more prominent than focal signs and may progress from confusion to stupor to coma.
Treatment consists of evacuation of the clot via burr holes. Antibiotics and antifungal agents have no role, and fibrinolytic therapy or delay in treatment could be harmful.

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QUESTION: 28

A63-year-old man complains of sudden onset of right-sided headache while at work. He rapidly becomes confused and lethargic. On examination, he is hemiparetic and has bilateral Babinski signs. ACT scan of the head is shown in the figure. What is the patient most likely to have?

an arteriovenous malformation
a carotid occlusion
hypertension
an underlying malignancy
abnormal clotting studies

Answer(s): C

Explanation:

The history and physical examination of the patient described in the question suggest either an intracerebral hemorrhage or a completed ischemic stroke. The CT scan that accompanies the question demonstrates a large hemorrhage in the region of the right basal ganglia with a surrounding zone of edema and narrowing of the ventricle. Patients with intracerebral hemorrhage often have a preceding history of hypertension. Carotid occlusion, malignancy, arteriovenous malformation, and coagulopathy all are much less likely causes of this disorder. In general, only cerebellar hemorrhages and cerebral hemorrhages that are easily reached are surgically evacuated. Most intracerebral hemorrhages are managed with general supportive care.

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