Webpath Exam 3 UPDATED Exam
Questions and CORRECT Answers
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 - Correct Answer- 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 - Correct Answer- 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 - Correct Answer- 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 - Correct Answer- 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 - Correct Answer- 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 - Correct Answer- 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 - Correct Answer- 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
Questions and CORRECT Answers
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 - Correct Answer- 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 - Correct Answer- 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 - Correct Answer- 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 - Correct Answer- 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 - Correct Answer- 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 - Correct Answer- 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 - Correct Answer- 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
