Wednesday, May 24, 2017

CMS neurology form 2 question on headache, seizures, urinary incontinence, broad based gait

Disclaimer: This is an CMS neurology form 2 question for step 2 CK. If you are planning to take USMLE step 2 CK in the future, I would recommend that you DO NOT read this post because it will bias your assessments.

2. A 47 year old woman comes to the physician because of a 4 month history pf difficulty walking, constant headache, and urinary incontinence. Her symptoms have worsened over the past month. Treatment with acetaminophen and ibuprofen has not relieved her headache. She has had mild memory impairment since a motor vehicle collision 5 years ago in which he lost consciousness. She has had two generalized tonic clonic seizures over the past year. Her sister has multiple sclerosis. The patient's vital signs are within normal limits. Examination shows normal strength in the upper and lower extremities and increased muscle tone in the lower extremities. Deep tendon reflexes are normal in the upper extremities and brisk in the lower extremities. Babinski sign is present bilaterally. Her gait is broad based and spastic. Sensation is intact. Which of the following is the most likely location of this patient's lesion?
A. Cauda equina
B. Cervical spinal cord
C. Parasagittal cerebral cortex
D. Pons
E. Thoracic spinal cord

It is not cauda equina since CES causes lower motor neuron kind of lesion.

Parasagittal lesions cause paraplegia. (The motor nuclei for each leg are in the medial aspect of the frontal lobe.)

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