Neuropathology Practice Questions

Question 1

A 73-year-old man is brought in by his wife with a history of progressive personality changes. The patient’s wife says that, over the past 3 years, he has become increasingly aggressive and easily agitated, which is extremely out of character for him. His wife also says that he has had several episodes of urinary incontinence in the past month. He has no significant past medical history. The patient denies any history of smoking, alcohol use, or recreational drug use. The patient is afebrile, and his vital signs are within normal limits. A physical examination is unremarkable. The patient takes the mini-mental status examination (MMSE) and scores 28/30. A T2 magnetic resonance image (MRI) of the head is performed and the results are shown in the exhibit (see image). Which of the following is the next best diagnostic step in the management of this patient?

Accepted Answer

Lumbar puncture

Answer

Contrast MRI of the head

Answer

Noncontrast CT of the head

Answer

Brain biopsy

Answer

Serum ceruloplasmin level

Question 2

A group of neurologists develop a new blood test for Alzheimer's. They are optimistic about the test, as they have found that for any given patient, the test repeatedly produces very similar results. However, they find that the new test results are not necessarily consistent with the gold standard of diagnosis. How would this new test most accurately be described?

Accepted Answer

Reliable

Answer

Valid and reliable

Answer

Valid

Answer

Biased

Answer

Neither valid nor reliable

Question 3

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?

Accepted Answer

MRI of the brain

Answer

Electroencephalography

Answer

PET scan

Answer

Lumbar puncture

Answer

Neuropsychologic testing

Question 4

A 57-year-old man is brought to the emergency department by his wife 20 minutes after having had a seizure. He has had recurrent headaches and dizziness for the past 2 weeks. An MRI of the brain shows multiple, round, well-demarcated lesions in the brain parenchyma at the junction between gray and white matter. This patient's brain lesions are most likely comprised of cells that originate from which of the following organs?

Accepted Answer

Lung

Answer

Kidney

Answer

Skin

Answer

Thyroid

Answer

Prostate

Question 5

A 70-year-old woman is brought to the office after her nurse noticed her being apathetic, easily distracted, and starting to urinate in bed. Her medical history is relevant for hypertension, under control with medication. Physical examination reveals a blood pressure of 138/76 mm Hg, a heart rate of 70/min, and a respiratory rate 14/min and regular. On neurological examination, she has a broad-based shuffling gait, and increased muscle tone in her limbs that is reduced by distracting the patient. There is decreased coordination with exaggerated deep tendon reflexes, decreased attention and concentration, and postural tremor. Which of the following additional features would be expected to find in this patient?

Accepted Answer

Dilation of the ventricular system

Answer

Degeneration of the substantia nigra pars compacta

Answer

Caudate head atrophy

Answer

Accumulation of Lewy bodies in cortical cells

Answer

Accumulation of amyloid plaques and neurofibrillary tangles in the cerebral cortex

Question 6

A research group wants to assess the safety and toxicity profile of a new drug. A clinical trial is conducted with 20 volunteers to estimate the maximum tolerated dose and monitor the apparent toxicity of the drug. The study design is best described as which of the following phases of a clinical trial?

Accepted Answer

Phase I

Answer

Phase 0

Answer

Phase III

Answer

Phase V

Answer

Phase II

Question 7

A 45-year-old man is brought to the hospital by his daughter with complaints of wide-based gait. His daughter reveals that he was sitting silently in the examination chair with a blank face. In addition, he was frequently talking to the empty chairs and told that his friends are sitting there. He has been forgetting many small things recently. On physical examination, fine movements are seen at resting condition that disappears when he is asked to drink water. A stepwise slowness in movement is also seen in his upper limb. Which of the following is most likely to be observed in the histological specimen of this patient?

Accepted Answer

Lewy bodies in affected neurons

Answer

Spongiform changes in cortex

Answer

Neuritic plaques in cortex

Answer

Tau protein aggregates in cortex

Answer

Neurofibrillary tangles in hippocampus

Question 8

An 81-year-old woman presents to your office accompanied by her husband. She has been doing well except for occasional word finding difficulty. Her husband is concerned that her memory is worsening over the past year. Recently, she got lost twice on her way home from her daughter’s house, was unable to remember her neighbor’s name, and could not pay the bills like she usually did. She has a history of hypertension and arthritis. She has no significant family history. Her medications include a daily multivitamin, hydrochlorothiazide, and ibuprofen as needed. Physical exam is unremarkable. Which of the following is associated with an increased risk of this patient’s disease?

Accepted Answer

ApoE4

Answer

Presenilin-2

Answer

ApoE2

Answer

Female gender

Answer

Advanced age (>85 years)

Question 9

A 53-year-old woman presents to her physician for evaluation of sudden onset respiratory distress for the past few hours. The past medical history includes a myocardial infarction 2 years ago. The vital signs include a blood pressure 70/40 mm Hg, pulse 92/min, respiratory rate 28/min, and SpO2 92% on room air. The physical examination reveals bilateral basal crepitations on auscultation. The echocardiogram reveals an ejection fraction of 34%. She is admitted to the medical floor and started on furosemide. The urine output in 24 hours is 400 mL. The blood urea nitrogen is 45 mg/dL and the serum creatinine is 1.85 mg/dL. The fractional excretion of sodium is 2.4%. Urinalysis revealed muddy brown granular casts. Which of the following is the most likely cause of the abnormal urinalysis?

Accepted Answer

Acute tubular necrosis

Answer

Acute interstitial nephritis

Answer

Acute pyelonephritis

Answer

Chronic kidney disease

Answer

Acute glomerulonephritis

Question 10

A 52-year-old man presents with 2 months of diarrhea, abdominal pain, and fatigue. He reports a weight loss of 4 kg (8 lb). He also says his joints have been hurting recently, as well. Past medical history is unremarkable. Review of systems is significant for problems with concentration and memory. Physical examination is unremarkable. A GI endoscopy is performed with a biopsy of the small bowel. Which of the following histologic finding would most likely be seen in this patient?

Accepted Answer

PAS positive macrophages

Answer

Non-caseating granulomas in the small intestine

Answer

Absence of nerves in the myenteric plexus

Answer

Blunting of the villi

Answer

Crypt hyperplasia with increased intraepithelial lymphocytes

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