HS 302 - The Nervous System

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smscherer
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91465
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HS 302 - The Nervous System
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2011-06-23 12:35:57
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congenital malformations trauma circulatory demyelinating metabolic neurodegenerative tumors
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The Nervous System (Central & Peripheral)
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  1. A 75-year-old woman appears well after slipping on wet pavement and striking the right side of her head. When questioned, she says that she does not remember the fall . Subsequently she complains of persistent headache and confusion.Magnetic imaging studies reveal a subdural hematoma over the lateral aspect of the right cerebral hemisphere. Which of the following is a well-known association or characteristic of this disorder?

    (A) Bleeding from arteries of the circle of Willis
    (B) Rapidly progressive cerebral compression
    (C) Characteristically caused by venous hemorrhage
    (D) Laceration of branches of middle meningeal artery
    (E) Causally associated with hyper tension
  2. A 2-year-old child presents with fever, headache, prostration, and nuchal rigidity. The cerebrospinal fluid (CSF) is cloudy, and microscopic examination reveals innumerable neutrophils. The CSF protein is increased, and glucose isdecreased. The most likely etiologic agent is...

    (A) Escherichia coli
    (B) Haemophilus influenzae
    (C) group B streptococci
    (D) Streptococcus pneumoniae
    (E) Staphylococcus aureus
  3. A 40-year-old woman who has had progressive localizing signs of central nervous system compression fully recovers following resection of an intracrania lneoplasm. These clinical findings are highly suggestive of a specific diagnosis. Assuming that this diagnosis is correct , which of the following is most characteristic?

    (A) Extracranial metastases
    (B) "Fried egg" appearance of tumor cells
    (C) Multiple areas of necrosis/hemorrhage in the tumor
    (D) Origin in arachnoidal cells of the meninges
    (E) Tumor cells arranged in a rosette pattern
  4. A newborn girl is found to have herniation of both the spinal cord and meninges through a defect in the vertebral arch of the spinal column. Her mother had not had prenatal care and had not taken nutritional supplements during pregnancy. Which of the following best describes this defect?

    (A) Spina bifida occulta
    (B) Meningocele
    (C) Meningomyelocele
    (D) Anencephaly
  5. Following a bar fight, a 22-year-old man is brought unconscious to the emergency department. Several minutes earlier , he had been hit on the head with a heavy iron club and had been briefly unconscious, but had then apparently recovered. One or two minutes later, he had again lost consciousness. Which of the following is the most likely diagnosis?

    (A) Epidural hematoma
    (B) Subarachnoid hemorrhage
    (C) Subdural hematoma
    (D) Transient ischemic attack
    (E) Stroke
  6. The figures shown here are representative of the gross and microscopic appearance of an autopsy specimen from a 55 -year -old woman who had a 1-year history of progressive headache and seizures leading to aphasia. The diagnosis is

    (A) ependymoma.
    (B) glioblastoma multiforme.
    (C) medul loblastoma.
    (D) meningioma.
    (E) oligodendroglioma.
  7. A 60-year -old woman with chronic atrial fibrillation is seen in the emergency department because of acute onset of marked weakness of her right arm, drooping of the left side of her face, and verbal aphasia. MRI reveals a cerebral infarct. Assuming that the lesion has been caused by embolizaton from the left atrium, which vessel is the most likely site of embolic arrest?

    (A) Right middle cerebral artery
    (B) Left middle cerebral artery
    (C) Right anterior cerebral artery
    (D) Left anterior cerebral artery
    (E) Right posterior cerebral artery
  8. A 25-year-old woman presents with brief episodes of loss of vision in her left eye, paresthesias (sensory loss) , and clumsiness in her hands. She states that these episodes come and go. MRI of the head reveals paraventricular plaques of demyelination in the central nervous system white matter . A cerebrospinal fluid (CSF) tap is performed. The patient is diagnosed with multiple sclerosis. Which of the following is the most likely finding in the CSF?

    (A) Acellular, with normal glucose and normal protein
    (B) Albumino-cytologic dissociation, with markedly increased protein but only modestly increased cell count
    (C) Increased immunoglobulin, manifesting as multiple oligoclonal bands on electrophoresis
    (D) Increased neutrophils, with decreased glucose and increased protein
  9. A 70-year-old man presents with loss of memory for recent events. He has forgotten his grandchildren's names, and he has been unable to manage his personal finances. Also, he has lost his way while driving to familiar locations. Which of the following is the most likely diagnosis?

    (A) Alzheimer disease
    (B) Amyotrophic lateral sclerosis
    (C) Creutzfeldt-Jakob disease
    (D) Huntington disease
    (E) Parkinson disease
  10. A 45-year-old man presents with involuntary facial grimaces and movements of the fingers. His mother had had similar symptoms beginning at about the same age. Her disorder had progressed to dancing movements, writhing of the arms and legs, and eventually coma and death. His maternal grandfather had had a similar disorder but at an age older than the mother. Which of the following is most characteristic of this disease?

    (A) Degeneration of upper and lower motor neurons
    (B) Dopamine depletion and depigmentation of the substantianigra
    (C) Increased number of trinucleotide repeats in a gene on chromosome 4
    (D) Neurofibrillary tangles and amyloid plaques in the cerebral cortex
    (E) Pick bodies, characterized by round intracytoplasmic inclusions consisting of neurofilaments
  11. Several years ago, a 60-year -old woman had presented with bradykinesia, rigidity, a resting pill-rolling tremor in her right hand, and "mask- like," expressionless facies. She currently presents with gait problems, taking short, shuffling steps and losing her balance easily. Which of the following is the most likely diagnosis?

    (A) Alzheimer disease
    (B) Amyotrophic lateral sclerosis
    (C) Creutzfeldt-Jakob disease
    (D) Huntington disease
    (E) Parkinson disease
  12. A 60-year-old man, a suicide victim, comes to autopsy. Before dying, he had been despondent after being informed that he had an extremely aggressive brain tumor. There had been a recent onset of headache, seizures, and mental status changes, and MRI had demonstrated an infiltrating neoplasm invading the cerebral hemispheres and crossing the midline, with areas of necrosis and abnormal blood vessels. The autopsy confirms the MRI findings and also demonstrates hemorrhage and a pseudopalisade arrangement of tumor cells. The tumor is most likely a(n)

    (A) ependymoma.
    (B) glioblastoma multiforme.
    (C) meningioma.
    (D) neurilemmoma (schwannoma) .
    (E) oligodendroglioma.
  13. A female neonate is noted at birth to have a gross deformity of her lower back. Examination of the subcutaneous scar reveals disorganized neural tissue with entrapment of nerve roots. What is the appropriate diagnosis?

    (A) Meningocele
    (B) Meningomyelocele
    (C) Rachischisis
    (D) Spina bifida occulta
    (E) Syringomyelia
  14. The parents of a neonate with a neural tube defect ask about the risks for similar birth defects in their future offspring. You mention that supplementation of the maternal diet can reduce the incidence of neural tube defects. What is this important dietary supplement?

    (A) Folic acid
    (B) Niacin
    (C) Thiamine
    (D) Vitamin B6
    (E) Vitamin B12
  15. A male neonate is noted at birth to have paralysis of the lower limbs. The infant fails to thrive and expires. The brainstem and cerebellum are examined at autopsy (shown). What is the diagnosis?

    (A) Anencephaly
    (B) Arnold-Chiari malformation
    (C) Holoprosencephaly
    (D) Hydromyelia
    (E) Lissencephaly
  16. A female neonate is noted to have a pronounced enlargement of her head (shown) . She develops convulsions. MRI reveals excessive accumulation of cerebrospinal fluid (CSF) , ventricular enlargement , atresia of the aqueduct of Sylvius, and atrophy of the cerebral cortex. This birth defect was most likely caused by which of the following mechanisms of disease?

    (A) Birth trauma
    (B) Congenital brain tumor
    (C) Ependymitis
    (D) Maternal folate deficiency
    (E) Oligohydramnios
  17. Which anatomic structure/region produced the CSF that accumulated in the brain of the neonate described in Question 4 (Hydrocephalus)?

    (A) Arachnoid
    (B) Choroid plexus
    (C) Corpus callosum
    (D) Pia mater
    (E) Subependymal areas of the cerebral hemispheres
  18. A 50-year-old man presents with a “staggering” gait and “lightning pain” in his hands and legs. His past medical history is significant for an aortic aneurysm and aortic insufficiency. Neurologic examination reveals impaired senses of vibration, as well as touch and pain in the lower extremities. The patient subsequently dies of pneumonia. Autopsy discloses obliterative endarteritis of meningeal blood vessels and atrophy of the posterior columns of the spinal cord. What is the appropriate diagnosis?

    (A) Amyotrophic lateral sclerosis
    (B) Friedreich ataxia
    (C) Huntington disease
    (D) Tabes dorsalis
    (E) Vitamin B12 deficiency (subacute combined degeneration)
  19. A 76-year-old man is admitted to the hospital for evaluation of progressive memory loss and disorientation. The pupils are small but react normally to light. Muscle tone is normal. A lumbar puncture returns clear, colorless CSF under normal pressure. A CT scan of the brain reveals broad sulci, atrophy of the gyri, and widening of the lateral ventricles. Which of the following is the most likely diagnosis?

    (A) Alzheimer disease
    (B) Creutzfeldt -Jakob disease
    (C) Glioblastoma multiforme
    (D) Huntington disease
    (E) Pick disease
  20. A 35-year -old man presents with a history of behavioral and personality changes and unusual involuntary movements. Physical examination reveals chorea and dystonia. The patient's mother and maternal grandfather had similar clinical symptoms. His mother died in a psychiatric institute, and his maternal grandfather committed suicide. MRI shows bilateral cerebral atrophy and enlargement of the lateral ventricles. Marked atrophy would also be expected in which of the following regions of this patient's brain?

    (A) Anterior horn of the spinal cord
    (B) Caudate nuclei
    (C) Cerebellum
    (D) Hypothalamus
    (E) Substantia nigra
  21. Which of the following gene abnormalities would be expected in the patient with Huntington’s diease?

    (A) Deletion of an exon in the gene for presenilin
    (B) Expansion of a trinucleotide repeat
    (C) Frame shift mutation in the gene for superoxide dismutase
    (D) Nondisjunction during meiosis of chromosome 21
    (E) Point mutation in the gene for the prion protein
  22. A 20-year-old woman with mild scoliosis complains of a 3-month history of difficulty walking. Physical and neurologic examinations reveal dysarthria, lower-limb areflexia, extensor plantar reflexes, and sensory loss. Genetic studies show evidence of a trinucleotide repeat expansion syndrome. The family asks for information regarding their daughter's prognosis. You are cognizant of the fact that the length of this chi ld's trinucleotide repeat is directly related to the rate of clinical progression, as well as the probability that she will develop which of the following life-threatening complications?

    (A) Aplastic anemia
    (B) Astrocytoma
    (C) Cardiomyopathy
    (D) Cerebral amyloidosis
    (E) Tuberous sclerosis
  23. A 35-year-old woman complains of urinary incontinence and blur red vision for 2 months. A funduscopic examination shows no abnormalities. Two months later, the patient develops double vision and numbness in the fingers of her left hand. MRI shows scattered plaques in the patient 's brain and spinal cord. Over the next several months, some of these plaques diminish in size, while others appear in new locations. These plaques would most likely show selective loss of which of the following proteins?

    (A) β -Amyloid
    (B) Glial fibrillary acidic protein
    (C) Myelin
    (D) Synaptophysin
    (E) α -Synuclein
  24. A 45-year-old woman is rushed to the emergency room following an automobile accident. Ten hours
    after admission, the patient complains of a severe headaches and blur red vision. An x-ray film of the cranium shows a fracture of the temporal-parietal bone. A CT scan reveals intracranial hemorrhage. Despite emergency craniotomy, the patient dies. Which of the following pathologic findings would be expected at autopsy?

    (A) Cerebellar hemorrhage
    (B) Epidural hematoma
    (C) Intracerebral hemorrhage
    (D) Intraventricular hemorrhage
    (E) Subarachnoid hemorrhage
  25. A 50-year-old woman presents with a 3-month history of easy
    fatigability, a smooth sore tongue, numbness and tingling of the feet
    ,and weakness of the legs. The hemoglobin is 5.6 g/dL, WBC count is
    5,100/μL, and platelets are 240,000/μL. A hematologic evaluation reveals
    a megaloblastic anemia that is not reversed by folate therapy.
    Peripheral neuropathy in this patient is most likely associated with
    which of the following pathologic findings?

    (A) Atrophy of frontal cortex
    (B) Atrophy of mammillary bodies
    (C) Degeneration of anterior horn cells in the spinal column
    (D) Degeneration of the posterior columns of the spinal cord
    (E) Spongi form degeneration of the cerebellum
  26. A 68-year-old woman complains of difficulty getting out of a chair. On examination, the patient shows reduced facial expression, a resting tremor, cogwheel rigidity, and bradykinesia. The patient dies of congestive heart failure 10 years later. Microscopic examination of brain tissue at autopsy is shown. The eosinophilic inclusions in the cytoplasm of this pigmented neuron are composed of which of the
    following proteins?

    (A) β -Amyloid
    (B) Polyglutamine
    (C) PrPsc
    (D) α -Synuclein (Lewy bodies)
    (E) Tau
  27. A 60-year-old man with a history of chronic bronchitis complains of difficulty walking. On examination, the patient appears stiff and stooped, shows an expressionless face, and speaks in a monotonous voice. A tremor of his fingers is apparent but ceases when he tries to reach for something. The patient dies 3 years later of metastatic lung cancer . At autopsy, the substantia nigra appears pale (shown). This pathologic finding is associated with which of the following biochemical changes?

    (A) Increased β-amyloid biosynthesis
    (B) Increased release of NMDA
    (C) Increased synthesis of GABA
    (D) Reduced levels of dopamine
    (E) Reduced tau protein self -assembly
  28. A 60-year-old chronic alcoholic was found in a state of mental confusion. Physical and neurologic examinations reveal horizontal diplopia, strabismus, amblyopia, nystagmus, ataxia, and peripheral neuropathy. The patient subsequently develops lobar pneumonia and expires. Examination of the brain at autopsy shows calcification and brownish discoloration of atrophic mammillary bodies. Petechiae in the quadrigeminal plate and periaqueductal regions of the midbrain are also observed. Which of the following best explains the pathogenesis of these clinical and pathologic findings?

    (A) AIDS- related encephalopathy
    (B) Amyotrophic lateral sclerosis
    (C) Hepatic encephalopathy
    (D) Hepatorenal syndrome
    (E) Thiamine deficiency
  29. A 15-year-old boy is rushed to the emergency room after suffering a tonic-clonic seizure 4 weeks after a spelunking expedition. The boy appears irritable and agitated, and his parents state that he has difficulty swallowing fluids.Lumbar puncture shows numerous lymphocytes. The patient becomes delirious, slips into a coma, and expires. At autopsy, the brain stem shows infiltrates of lymphocytes around small blood vessels and evidence of neuronophagia. Some neurons contain eosinophilic inclusions. What is the proper name for these neuronal inclusions?

    (A) Councilman bodies
    (B) Hirano bodies
    (C) Lewy bodies
    (D) Negri bodies
    (E) Psammoma bodies
  30. A 10-month-old girl is brought to the emergency room with severe, unremitting watery diarrhea. Her blood pressure is 80 mm Hg systolic, and the pulse is 120/min. Which of the following is a potentially lethal complication of systemic dehydration in this patient?

    (A) Diffuse axonal shearing
    (B) Intraventricular hemorrhage
    (C) Midbrain hemorrhage
    (D) Pontine hemorrhage
    (E) Venous sinus thrombosis
  31. A 54-year-old woman dies 48 hours after suffering severe head injuries in an automobile accident. Just before her death, her left pupil becomes fixed and dilated. An inferior view of the patient 's brain at autopsy is shown. Which of the following was the most likely cause of death?

    (A) Diffuse axonal shearing
    (B) Laminar necrosis
    (C) Thrombosis of sagittal sinus
    (D) Transtentorial herniation
    (E) Watershed infarct
  32. An 18-year-old man suffers massive trauma in a motorcycle accident. A CT scan shows multiple intracerebral hemorrhages. The patient expires after 6 months in a coma. At autopsy, there are cystic cavities within the frontal and temporal lobes, corresponding to the areas of prior hemorrhage. These cavities were formed in large measure due to the phagocytic activity of which of the following cell types?

    (A) Astrocytes
    (B) Endothelial cells
    (C) Microglial cells
    (D) Neutrophils
    (E) Oligodendrocytes
  33. A 22-year-old boxer suffers a concussion during a boxing match and is rushed to the emergency room. According to his trainer, the blow deflected his head upwards and posteriorly. Loss of consciousness in this patient presumably occurred because of a functional paralysis of neurons in which of the following anatomic regions of his brain?

    (A) Brainstem reticular formation
    (B) Cerebellum
    (C) Hypothalamus
    (D) Periventricular white matter
    (E) Temporoparietal area
  34. The patient described in Question 28 (subdural hematoma, concussion) persists in a vegetative coma for several months and then expires. A section of the temporal lobe shows massive proliferation of cells with a star-shaped appearance (shown) . Which of the following best accounts for this cellular response to injury?

    (A) Axonal regeneration
    (B) Chromatolysis
    (C) Gliosis
    (D) Leukodystrophy
    (E) Neuronophagia
  35. A 68-year-old obese woman (BMI = 34 kg/m2 ) suffers a stroke and expires. Histologic examination of the brain at autopsy reveals extensive arteriolar lipohyalinosis and numerous Charcot-Bouchard aneurysms. Which of the following best accounts for the pathogenesis of these autopsy findings?

    (A) Atherosclerosis
    (B) Autoimmunity
    (C) Diabetes
    (D) Hypertension
    (E) Vasculitis
  36. A 12-year-old boy is rushed to the emergency room in a coma after falling from an upper story window of his home. MRI shows a subdural hematoma over the left hemisphere. What is the most likely source of intracranial bleeding in this patient?

    (A) Bridging veins
    (B) Charcot -Bouchard aneurysm
    (C) Internal carotid artery
    (D) Middle meningeal artery
    (E) Sagittal sinus
  37. A 5-year-old boy is brought to the emergency room with fever, vomiting, and convulsions. The patient is febrile to 39.5°C (104°F). Physical examination reveals cervical rigidity and pain in the neck and knees. Acute inflammation most likely involves which anatomic region of the patient's brain?

    (A) Choroid plexus
    (B) Ependyma
    (C) Hypothalamus
    (D) Lateral ventricles
    (E) Leptomeninges
  38. A 32-year -old woman presents with a 2-day history of headache, vomiting, and fever. Physical examination reveals cervical rigidity and knee pain with hip flexion. Lumbar puncture demonstrates an abundance of neutrophils and decreased levels of glucose. Which of the following diseases is most likely associated with these clinical laboratory findings?

    (A) Meningococcal meningitis
    (B) Neurosarcoidosis
    (C) Staphylococcal meningitis
    (D) Tuberculous meningitis
    (E) Viral meningitis
  39. A 1-year-old boy presents with a delay in motor development. Progressive muscle weakness and blindness ensue, and the patient dies within a year. The brain at autopsy shows swollen neurons that contain numerous lysosomes filled with lipid. Which of the following is the most likely diagnosis?

    (A) AL amyloidosis
    (B) Hurler syndrome
    (C) Phenylketonuria
    (D) Tay-Sachs disease
    (E) Tuberous sclerosis
  40. A 48-year -old man with AIDS is admitted to the hospital with a headache, fever of 38.7°C (103°F) , and persistent cough. His CD4 cell count is <500/μL. Lumbar puncture returns cloudy fluid, and microscopic examination shows numerous encapsulated microorganisms (shown). Which of the following pathogens is the most likely cause of meningitis in this patient?

    (A) Aspergillus flavus
    (B) Cryptococcus neoformans
    (C) Mycobacterium tuberculosis
    (D) Neisseria meningitidis
    (E) Toxoplasma gondii
  41. A 30-year-old woman presents to the emergency room complaining that she has the “worst headache” of her life. Her temperature is 37°C (98.6°F) , blood pressure is 135/85 mm Hg, and pulse is 90 /min. The patient shows no evidence of muscle weakness or ataxia. Imaging studies reveal subarachnoid hemorrhage, and an angiogram shows a saccular aneurysm. Which of the following best describe the pathogenesis of aneurysm formation in this patient?

    (A) Atherosclerosis
    (B) Bacterial infection
    (C) Developmental vascular weakness
    (D) Diabetes mellitus
    (E) Systemic hypertension
  42. Which of the following is the most likely anatomic location of the ruptured aneurysm in the patient described in Quest ion 35 (she has a Berry aneurysm)?

    (A) Circle of Willis
    (B) Internal carotid artery
    (C) Middle meningeal artery
    (D) Striate artery
    (E) Vertebral artery
  43. A 27-year-old man presents with dementia, weakness, visual loss, and ataxia 1 year after receiving a cadaveric kidney transplant. Which of the following is the most likely cause of this patient 's CNS disorder?

    (A) Adrenoleukodystrophy
    (B) Gaucher disease
    (C) Metachromatic leukodystrophy
    (D) Progressive multi-focal leukoencephalopathy
    (E) Subacute sclerosing panencephalitis
  44. A 45-year-old man with AIDS is admitted to the hospital with a productive cough, fever, and night sweats. An x-ray film of the chest shows an ill-defined area of consolidation at the periphery of the right middle lobe and mediastinal lymphadenopathy. A sputum culture grows acid-fast bacilli. The patient develops severe headache and neck rigidity. Which of the following brain areas is most likely affected by this patient's infection?

    (A) Base of the brain
    (B) Cerebellum
    (C) Hippocampus
    (D) Periventricular white matter
    (E) Temporal-occipital sulcus
  45. A 30-year-old woman suffers massive trauma in an automobile accident and expires 4 days later of respiratory insufficiency. A horizontal section of the patient's brain at autopsy reveals numerous petechiae scattered throughout the white matter. Which of the following is the most likely explanation for this pathologic finding?

    (A) Fat embolism
    (B) Global ischemia
    (C) Occlusion of middle cerebral artery
    (D) Sepsis
    (E) Uremia
  46. A 55-year-old man is brought to the emergency room after a near-drowning accident while boating. The patient has no pulse when the paramedics arrive, but he is resuscitated. The patient never regains consciousness and expires 3 days later. Examination of the brain at autopsy reveals a watershed zone of infarction in the left cerebral hemisphere. Which of the following best describes the pathogenesis of this infarct?

    (A) Disseminated intravascular coagulation
    (B) Prolonged hypotension
    (C) Sagittal sinus thrombosis
    (D) Spontaneous cerebral hemorrhage
    (E) Thromboembolism
  47. A 2-year-old boy is brought to the physician by his parents, who complain that their son continually loses his balance. They also report that his speech seems more slurred. Physical examination confirms the truncal ataxia and wide-based gait. The child appears lethargic, and there is bobbing of the head while he is sitting. Muscle tone is normal. This patient may have a midline tumor in which anatomic portion of the brain?

    (A) Cerebellum
    (B) Corpus callosum
    (C) Frontal lobes
    (D) Hypothalamus
    (E) Meninges
  48. A 65-year-old woman presents with a 3-week history of intractable headaches. Her vital signs and CBC are normal. Two weeks later, the patient develops left-sided hemiparesis. MRI reveals a large, necrotic tumor in the right hemisphere of the cerebrum, extending across the corpus callosum into the left hemisphere. A coronal sect ion of the patient 's brain at autopsy is shown. This tumor is most likely derived from which of the following cell types?

    (A) Astrocytes
    (B) Ependymal lining cells
    (C) Microglia
    (D) Neurons
    (E) Oligodendroglia
  49. A 50-year-old man presents with a 5-month history of severe headaches. Vital signs and CBC are normal. Imaging studies demonstrate a mass in the fourth ventricle and hydrocephalus. The results of a CT-guided biopsy are shown. What is the appropriate diagnosis for this patient 's malignant neoplasm?

    (A) Craniopharyngioma
    (B) Ependymoma
    (C) Glioblastoma multiforme
    (D) Oligodendroglioma
    (E) Schwannoma
  50. A 45-year-old woman is brought to the emergency room after experiencing a generalized seizure. An x-ray film of the skull reveals a lytic bone mass. A CBC is normal. A portion of the skull and the adherent mass are removed. Microscopic examination of the surgical specimen is shown. What is the appropriate diagnosis?

    (A) Glioblastoma multiforme
    (B) Hemangioblastoma
    (C) Medul loblastoma
    (D) Meningioma
    (E) Oligodendroglioma
  51. A 48-year-old man with AIDS is admitted to the hospital with a fever of 38.7°C (103°F), persistent cough, and diarrhea. His CD4 cell count is <500/μL. The patient is started on broad-spectrum antibiotics. He has also experienced a recent decline in cognitive function. He is at increased risk of developing which of the following CNS neoplasms?

    (A) Ependymoma
    (B) Glioblastoma
    (C) Lymphoma
    (D) Medul loblastoma
    (E) Oligodendroglioma
  52. A 35-year-old man with Down syndrome dies of acute lympho-blastic leukemia. Gross examination of the patient 's brain at autopsy shows mild microcephaly and underdevelopment of the superior temporal gyri. Histologic examinat ion would most likely show which of the following neuropathologic changes?

    (A) AA amyloidosis
    (B) Lewy bodies
    (C) Negri bodies
    (D) Neurofibrillary tangles
    (E) Spongiform encephalopathy
  53. A 14-year-old girl is rushed to the emergency room after receiving a gunshot wound to the head and is pronounced dead on arrival. If this child died due to an immediate “blast effect” of the penetrating wound, the autopsy would likely show herniation of the tonsils of the cerebellum into which anatomic space?

    (A) Aqueduct of Sylvius
    (B) Central spinal canal
    (C) Foramen magnum
    (D) Foramen of Magendie
    (E) Posterior fossa

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