MRI principles and interpretation — MCQs

A 72-year-old man is brought to the physician by his wife for memory issues over the last 7 months. The patient's wife feels that he has gradually become more forgetful. He commonly misplaces his car keys and forgets his children's names. He seems to have forgotten how to make dinner and sometimes serves uncooked noodles or raw meat. One night he parked his car in a neighbor's bushes and was found wandering the street. He has a history of hypertension, hyperlipidemia, and COPD. Current medications include atorvastatin, metoprolol, ipratropium, and fluticasone. Vital signs are within normal limits. He is alert and oriented to person and place only. Neurologic examination shows no focal findings. His Mini-Mental State Examination score is 19/30. A complete blood count and serum concentrations of electrolytes, urea nitrogen, creatinine, thyroid-stimulating hormone, liver function tests, vitamin B12 (cobalamin), and folate are within the reference range. Which of the following is the most appropriate next step in diagnosis?

A 36-year-old male is taken to the emergency room after jumping from a building. Bilateral fractures to the femur were stabilized at the scene by emergency medical technicians. The patient is lucid upon questioning and his vitals are stable. Pain only at his hips was elicited. Cervical exam was not performed. What is the best imaging study for this patient?

A 65-year-old man is referred by his primary care provider to a neurologist for leg pain. He reports a 6-month history of progressive bilateral lower extremity pain that is worse in his left leg. The pain is 5/10 in severity at its worst and is described as a "burning" pain. He has noticed that the pain is acutely worse when he walks downhill. He has started riding his stationary bike more often as it relieves his pain. His past medical history is notable for hypertension, diabetes mellitus, and a prior myocardial infarction. He also sustained a distal radius fracture the previous year after falling on his outstretched hand. He takes aspirin, atorvastatin, metformin, glyburide, enalapril, and metoprolol. He has a 30-pack-year smoking history and drinks 2-3 glasses of wine with dinner every night. His temperature is 99°F (37.2°C), blood pressure is 145/85 mmHg, pulse is 91/min, and respirations are 18/min. On exam, he is well-appearing and in no acute distress. A straight leg raise is negative. A valsalva maneuver does not worsen his pain. Which of the following is the most appropriate test to confirm this patient's diagnosis?

A 40-year-old man comes to the physician because of weight gain over the past 3 months. During this period, he has gained 10 kg (22 lb) unintentionally. He also reports decreased sexual desire, oily skin, and sleeping difficulties. There is no personal or family history of serious illness. He has smoked one pack of cigarettes daily for the past 10 years. The patient appears lethargic. His temperature is 37°C (98.6°F), pulse is 80/min, and blood pressure is 150/90 mm Hg. Physical examination shows central obesity, acne, and thin, easily bruisable skin with stretch marks on the abdomen. There is darkening of the mucous membranes and the skin creases. Examination of the muscles shows atrophy and weakness of proximal muscle groups. His serum glucose concentration is 240 mg/dL. Which of the following findings would most likely be present on imaging?

A 60-year-old male is admitted to the ICU for severe hypertension complicated by a headache. The patient has a past medical history of insulin-controlled diabetes, hypertension, and hyperlipidemia. He smokes 2 packs of cigarettes per day. He states that he forgot to take his medications yesterday and started getting a headache about one hour ago. His vitals on admission are the following: blood pressure of 160/110 mmHg, pulse 95/min, temperature 98.6 deg F (37.2 deg C), and respirations 20/min. On exam, the patient has an audible abdominal bruit. After administration of antihypertensive medications, the patient has a blood pressure of 178/120 mmHg. The patient reports his headache has increased to a 10/10 pain level, that he has trouble seeing, and he can't move his extremities. After stabilizing the patient, what is the best next step to diagnose the patient's condition?

A new drug X is being tested for its effect on renal function. During the experiments, the researchers found that in patients taking substance X, the urinary concentration of sodium decreases while urine potassium concentration increase. Which of the following affects the kidneys in the same way as does substance X?

During the course of investigation of a suspected abdominal aortic aneurysm in a 57-year-old woman, a solid 6 × 5 cm mass is detected in the right kidney. The abdominal aorta reveals no abnormalities. The patient is feeling well and has no history of any serious illness or medication usage. She is a 25-pack-year smoker. Her vital signs are within normal limits. Physical examination reveals no abnormalities. Biopsy of the mass shows renal cell carcinoma. Contrast-enhanced CT scan indicates no abnormalities involving contralateral kidney, lymph nodes, lungs, liver, bone, or brain. Which of the following treatment options is the most appropriate next step in the management of this patient?

A 67-year-old man presents to his primary care provider with bloody urine. He first noticed the blood 1 week ago. He otherwise feels healthy. His past medical history is significant for type 2 diabetes mellitus for 18 years, for which he takes insulin injections. He has smoked 30–40 cigarettes per day for the past 29 years and drinks alcohol socially. Today his vital signs include: temperature 36.6°C (97.8°F), blood pressure 135/82 mm Hg, and heart rate 105/min. There are no findings on physical examination. Urinalysis shows 15–20 red cells/high power field. Which of the following is the next best test to evaluate this patient’s condition?

A 65-year-old man presents to the emergency department for sudden weakness. He was doing mechanical work on his car where he acutely developed right-leg weakness and fell to the ground. He is accompanied by his wife, who said that this has never happened before. He was last seen neurologically normal approximately 2 hours prior to presentation. His past medical history is significant for hypertension and type II diabetes. His temperature is 98.8°F (37.1°C), blood pressure is 177/108 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 99% on room air. Neurological exam reveals that he is having trouble speaking and has profound weakness of his right upper and lower extremity. Which of the following is the best next step in management?

Arrange in sequence the structures involved in the direct pathway (1=Striatum, 2=GPi, 3=Thalamus, 4=Cortex output, 5=Cortex input):-