1000+ Basics of Neurology MCQ for GATE [Solved]
Thursday 9th of March 2023
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1. Topic: Delirium Tremens
Subject: Medicine
A patient with delirium tremens manifests all of the following, except:
A. Clouded consciousness
B. Hypothermia
C. Coarse tremor
D. Tachypnea
Answer : B
Subject: Medicine
A patient with delirium tremens manifests all of the following, except:
A. Clouded consciousness
B. Hypothermia
C. Coarse tremor
D. Tachypnea
Answer : B
2. Topic: Normal Pressure Hydrocephalus
Subject: Medicine
A previously alert, otherwise healthy 74-year-old black male has a history of slowly developing progressive memory loss and dementia associated with urinary incontinence and gait disturbance resembling ataxia.
This presentation is most consistent with:
A. Normal pressure hydrocephalus
B. Alzheimers disease
C. Subacute sclerosing panencephalitis
D. Multiple sclerosis
Answer : A
Subject: Medicine
A previously alert, otherwise healthy 74-year-old black male has a history of slowly developing progressive memory loss and dementia associated with urinary incontinence and gait disturbance resembling ataxia.
This presentation is most consistent with:
A. Normal pressure hydrocephalus
B. Alzheimers disease
C. Subacute sclerosing panencephalitis
D. Multiple sclerosis
Answer : A
3. Topic: Seizure
Subject: Medicine
Of the following, which is the most frequent cause of seizures in the elderly?
A. Alcohol withdrawal
B. Stroke
C. Head trauma
D. Hypoglycemia
Answer : B
Subject: Medicine
Of the following, which is the most frequent cause of seizures in the elderly?
A. Alcohol withdrawal
B. Stroke
C. Head trauma
D. Hypoglycemia
Answer : B
4. Topic: Alzheimer's Disease
Subject: Medicine
An 84-year-old black female is brought to your office by her daughter, who is concerned that the mother has memory problems and is neglecting to pay her monthly bills. The mother also is forgetting appointments and asks the same questions repeatedly. This problem has been steadily worsening over the last 1-2 years. The patient has very little insight into her problems, scores 24 out of a possible 30 points on the Mini-Mental State Examination, and has difficulty with short-term recall and visuospatial tasks. Her physical examination and a thorough laboratory workup are normal. A CT scan of the brain reveals diffuse atrophy. Which one of the following is the most likely etiology for the patients memory problem?
A. Alzheimers disease
B. Dementia resulting from depression
C. Lewy body dementia
D. Multi-infarct dementia
Answer : A
Subject: Medicine
An 84-year-old black female is brought to your office by her daughter, who is concerned that the mother has memory problems and is neglecting to pay her monthly bills. The mother also is forgetting appointments and asks the same questions repeatedly. This problem has been steadily worsening over the last 1-2 years. The patient has very little insight into her problems, scores 24 out of a possible 30 points on the Mini-Mental State Examination, and has difficulty with short-term recall and visuospatial tasks. Her physical examination and a thorough laboratory workup are normal. A CT scan of the brain reveals diffuse atrophy. Which one of the following is the most likely etiology for the patients memory problem?
A. Alzheimers disease
B. Dementia resulting from depression
C. Lewy body dementia
D. Multi-infarct dementia
Answer : A
5. Topic: Adverse Drug Effect
Subject: Medicine
Which one of the following is most associated with falls in older adults?
A. Diphenhydramine (Benadryl)
B. Atorvastatin (Lipitor)
C. Metformin (Glucophage)
D. Memantine (Namenda)
Answer : A
Subject: Medicine
Which one of the following is most associated with falls in older adults?
A. Diphenhydramine (Benadryl)
B. Atorvastatin (Lipitor)
C. Metformin (Glucophage)
D. Memantine (Namenda)
Answer : A
6. Topic: Korsakoff's Psychosis
Subject: Medicine
In a patient with recent onset of alcohol amnestic disorder, the mental status test most likely to be done poorly is memory of:
A. Political figures of 10 years ago
B. Digits (forward)
C. His own name
D. Three items for 5 minutes
Answer : D
Subject: Medicine
In a patient with recent onset of alcohol amnestic disorder, the mental status test most likely to be done poorly is memory of:
A. Political figures of 10 years ago
B. Digits (forward)
C. His own name
D. Three items for 5 minutes
Answer : D
7. Topic: Cauda Equina Syndrome
Subject: Medicine
A 65-year-old male presents with a 1-month history of problems passing urine. He says that his bladder will feel full when he needs to urinate, but the urine stream is weak and his bladder does not feel as if it has emptied completely. The symptoms have become increasingly severe over the past week. Other symptoms include upper respiratory congestion for 3 days which he has treated with an over-thecounter decongestant with some relief, constipation with no passage of stool in the past 9 days, and increasing low back pain incompletely relieved with ibuprofen, with associated weakness in both legs. Examination shows a healthy-appearing male who is moderately overweight. He is afebrile and vital signs are normal. There is no abdominal tenderness and no masses are detected. A rectal examination reveals a large amount of hard stool in the rectum; a markedly enlarged (4+), boggy, tender prostate gland; laxity of the anal sphincter; and numbness in the perianal area. Urinalysis shows trace protein and 10-20 WBCs/hpf. Ultrasonography shows a post-void residual volume of 250 mL (normal for age <100).
Which one of the following must be done urgently in this patient?
A. Foley catheterization
B. Hospitalization for intravenous antibiotics
C. Digital disimpaction of the rectum, and Fleet enemas until clear
D. MRI of the lumbosacral spine
Answer : D
Subject: Medicine
A 65-year-old male presents with a 1-month history of problems passing urine. He says that his bladder will feel full when he needs to urinate, but the urine stream is weak and his bladder does not feel as if it has emptied completely. The symptoms have become increasingly severe over the past week. Other symptoms include upper respiratory congestion for 3 days which he has treated with an over-thecounter decongestant with some relief, constipation with no passage of stool in the past 9 days, and increasing low back pain incompletely relieved with ibuprofen, with associated weakness in both legs. Examination shows a healthy-appearing male who is moderately overweight. He is afebrile and vital signs are normal. There is no abdominal tenderness and no masses are detected. A rectal examination reveals a large amount of hard stool in the rectum; a markedly enlarged (4+), boggy, tender prostate gland; laxity of the anal sphincter; and numbness in the perianal area. Urinalysis shows trace protein and 10-20 WBCs/hpf. Ultrasonography shows a post-void residual volume of 250 mL (normal for age <100).
Which one of the following must be done urgently in this patient?
A. Foley catheterization
B. Hospitalization for intravenous antibiotics
C. Digital disimpaction of the rectum, and Fleet enemas until clear
D. MRI of the lumbosacral spine
Answer : D
8. Topic: Brain Death
Subject: Medicine
A 57-year-old white male with coronary artery disease suffered a cardiac arrest while jogging 10 days ago. He was resuscitated after 45 minutes but has remained unresponsive and on a ventilator since then.
Which one of the following is required to diagnose brain death in this patient?
A. Hypothermia
B. Continuous mechanical ventilation
C. The absence of spontaneous body movements
D. Electroencephalographic confirmation
Answer : D
Subject: Medicine
A 57-year-old white male with coronary artery disease suffered a cardiac arrest while jogging 10 days ago. He was resuscitated after 45 minutes but has remained unresponsive and on a ventilator since then.
Which one of the following is required to diagnose brain death in this patient?
A. Hypothermia
B. Continuous mechanical ventilation
C. The absence of spontaneous body movements
D. Electroencephalographic confirmation
Answer : D
9. Topic: Neurologic pain
Subject: Medicine
A 21-year-old man presented to the emergency hospital with severe abdominal pain. The pain started four hour ago. His medical history reveals Acute Intermittent Porphyria (AIP) and he used to have frequent attacks of abdominal pain and believes that this attack is no different. On examination, the patient is in acute pain and slightly feverish but not pale, jaundiced or cyanosed. However, his blood pressure is found to be high and he has tachycardia.
You should consider a diagnosis other than an AIP attack if the pain is associated with:
A. Constipation
B. Tenderness
C. Abdominal distension
D. Decreased bowel sounds
Answer : B
Subject: Medicine
A 21-year-old man presented to the emergency hospital with severe abdominal pain. The pain started four hour ago. His medical history reveals Acute Intermittent Porphyria (AIP) and he used to have frequent attacks of abdominal pain and believes that this attack is no different. On examination, the patient is in acute pain and slightly feverish but not pale, jaundiced or cyanosed. However, his blood pressure is found to be high and he has tachycardia.
You should consider a diagnosis other than an AIP attack if the pain is associated with:
A. Constipation
B. Tenderness
C. Abdominal distension
D. Decreased bowel sounds
Answer : B
10. Topic: Subarachnoid Hemorrhage
Subject: Medicine
A 25-year-old male presents 5 hours after the onset of the worst headache of my life. His temperature is 37.0°C (98.6°F), blood pressure 140/90 mm Hg, respiratory rate 20/min, and pulse rate 90 beats/min. The patient is lethargic but oriented; there are no focal neurologic findings, but neck stiffness is present. Unenhanced CT of the head is negative. You elect to perform a lumbar puncture. At this time, which one of the following findings in bloody spinal fluid would indicate a diagnosis of subarachnoid hemorrhage?
A. Yellow-orange cerebrospinal fluid supernatant
B. A WBC:RBC ratio of 1/1000
C. A protein (g/L) to RBC (count/L) of 1/1000
D. A glucose level below 2.2 mmol/L
Answer : A
Subject: Medicine
A 25-year-old male presents 5 hours after the onset of the worst headache of my life. His temperature is 37.0°C (98.6°F), blood pressure 140/90 mm Hg, respiratory rate 20/min, and pulse rate 90 beats/min. The patient is lethargic but oriented; there are no focal neurologic findings, but neck stiffness is present. Unenhanced CT of the head is negative. You elect to perform a lumbar puncture. At this time, which one of the following findings in bloody spinal fluid would indicate a diagnosis of subarachnoid hemorrhage?
A. Yellow-orange cerebrospinal fluid supernatant
B. A WBC:RBC ratio of 1/1000
C. A protein (g/L) to RBC (count/L) of 1/1000
D. A glucose level below 2.2 mmol/L
Answer : A
11. Topic: Status Epilepticus
Subject: Medicine
A 58-year-old male with a history of seizure attacks suffered from a 30 min loss of consciousness with repetitive seizures with no recovery of consciousness between attacks. What is the disorder this patient is suffering from?
A. Tonic-clonic seizure
B. Absence seizure
C. Atonic seizure
D. Status epilepticus
Answer :
Subject: Medicine
A 58-year-old male with a history of seizure attacks suffered from a 30 min loss of consciousness with repetitive seizures with no recovery of consciousness between attacks. What is the disorder this patient is suffering from?
A. Tonic-clonic seizure
B. Absence seizure
C. Atonic seizure
D. Status epilepticus
Answer :
12. Topic: Benign Positional Vertigo
Subject: Medicine
Which one of the following is characteristic of benign positional vertigo?
A. A duration of 10-15 minutes
B. Associated hearing loss and tinnitus
C. Associated diplopia and facial numbness
D. Being triggered by turning the head
Answer : D
Subject: Medicine
Which one of the following is characteristic of benign positional vertigo?
A. A duration of 10-15 minutes
B. Associated hearing loss and tinnitus
C. Associated diplopia and facial numbness
D. Being triggered by turning the head
Answer : D
13. Topic: Delirium Tremens
Subject: Medicine
You see a 49-year-old man in the emergency room with a 20-year-history of alcohol abuse. He is agitated and floridly psychotic, with visual hallucinations and persecutory delusions. On examination his blood pressure, heart rate and respiratory rate are all increased. He is disoriented, sweaty, and has abdominal cramps.
What is the most likely diagnosis?
A. Subdural hematoma
B. Alcohol intoxication
C. Hepatic encephalopathy
D. Delirium tremens
Answer : D
Subject: Medicine
You see a 49-year-old man in the emergency room with a 20-year-history of alcohol abuse. He is agitated and floridly psychotic, with visual hallucinations and persecutory delusions. On examination his blood pressure, heart rate and respiratory rate are all increased. He is disoriented, sweaty, and has abdominal cramps.
What is the most likely diagnosis?
A. Subdural hematoma
B. Alcohol intoxication
C. Hepatic encephalopathy
D. Delirium tremens
Answer : D
14. Topic: Temporal Arteritis
Subject: Medicine
A 70-year-old woman returns to the office because of aching and weakness in her arms to the point where she cannot lift her arm to brush her hair. Physical examination shows no muscle tenderness or other evidence of joint disease in both arms. The aching improves when she takes the prescribed nonsteroidal anti-inflammatory drug (NSAID). She also describes tenderness over the right temporal area of her scalp. Physical examination of the scalp shows no lesions.
Which of the following is the most appropriate next step?
A. Increase the dose of the NSAID
B. Order determination of erythrocyte sedimentation rate
C. Order determination of serum rheumatoid factor
D. Order x-ray films of the cervical spine
Answer : B
Subject: Medicine
A 70-year-old woman returns to the office because of aching and weakness in her arms to the point where she cannot lift her arm to brush her hair. Physical examination shows no muscle tenderness or other evidence of joint disease in both arms. The aching improves when she takes the prescribed nonsteroidal anti-inflammatory drug (NSAID). She also describes tenderness over the right temporal area of her scalp. Physical examination of the scalp shows no lesions.
Which of the following is the most appropriate next step?
A. Increase the dose of the NSAID
B. Order determination of erythrocyte sedimentation rate
C. Order determination of serum rheumatoid factor
D. Order x-ray films of the cervical spine
Answer : B
15. Topic: Seizure
Subject: Medicine
A 52-year-old male with a history of seizure attacks suffered from loss of consciousness and tonic and clonic muscular contractions. His tongue fell back into the throat and he choked. What is the most likely diagnosis of this presentation?
A. Petit mal seizure
B. Grand mal seizure
C. Myoclonic seizure
D. Atonic seizure
Answer : B
Subject: Medicine
A 52-year-old male with a history of seizure attacks suffered from loss of consciousness and tonic and clonic muscular contractions. His tongue fell back into the throat and he choked. What is the most likely diagnosis of this presentation?
A. Petit mal seizure
B. Grand mal seizure
C. Myoclonic seizure
D. Atonic seizure
Answer : B
16. Topic: Tension headache.
Subject: Medicine
A woman presents with chief complaint of tightening, band-like headaches that usually occur upon rising in the morning. What is the most likely diagnosis?
A. Migraine headache
B. Premenstrual headache
C. Tension headache
D. Cluster headache
Answer : C
Subject: Medicine
A woman presents with chief complaint of tightening, band-like headaches that usually occur upon rising in the morning. What is the most likely diagnosis?
A. Migraine headache
B. Premenstrual headache
C. Tension headache
D. Cluster headache
Answer : C
17. Topic: Alzheimer's Disease
Subject: Medicine
Which one of the following is most predictive of the progression from mild cognitive impairment to frank Alzheimers dementia?
A. Self-reported memory deficits
B. Memory deficits reported by a family member
C. A normal MRI scan of the brain
D. The absence of the apolipoprotein E4 allele
Answer : B
Subject: Medicine
Which one of the following is most predictive of the progression from mild cognitive impairment to frank Alzheimers dementia?
A. Self-reported memory deficits
B. Memory deficits reported by a family member
C. A normal MRI scan of the brain
D. The absence of the apolipoprotein E4 allele
Answer : B
18. Topic: Glasgow Coma Scale
Subject: Medicine
A 27 year old man is brought into the ER after a bicycling accident. A car door suddenly opened in front of him, of which he smashed into and was thrown 15 feet. On examination, he is drowsy and confused. He opens his eyes when his name is called. When he speaks, you understand his words but the sentences do not make sense. He moves all four limbs but does not respond to any commands. He is able to pull both hands away when pinched and squirms when his sternum is rubbed, making no effort to stop you.
What is his Glasgow Coma Scale score?
A. 11
B. 10
C. 9
D. 8
Answer : B
Subject: Medicine
A 27 year old man is brought into the ER after a bicycling accident. A car door suddenly opened in front of him, of which he smashed into and was thrown 15 feet. On examination, he is drowsy and confused. He opens his eyes when his name is called. When he speaks, you understand his words but the sentences do not make sense. He moves all four limbs but does not respond to any commands. He is able to pull both hands away when pinched and squirms when his sternum is rubbed, making no effort to stop you.
What is his Glasgow Coma Scale score?
A. 11
B. 10
C. 9
D. 8
Answer : B
19. Topic: Adverse Drug Effect
Subject: Medicine
A 68-year-old man with a history of urolithiasis, suffered from a seizure attack which involved loss of consciousness with tonic and clonic muscular contractions. His tongue fell back into his throat and he choked. He is treated with valproic acid.
What are the most common side effects caused by this medication?
A. Weight gain
B. Rash
C. Nausea and headache
D. Tardive dyskinesia
Answer : C
Subject: Medicine
A 68-year-old man with a history of urolithiasis, suffered from a seizure attack which involved loss of consciousness with tonic and clonic muscular contractions. His tongue fell back into his throat and he choked. He is treated with valproic acid.
What are the most common side effects caused by this medication?
A. Weight gain
B. Rash
C. Nausea and headache
D. Tardive dyskinesia
Answer : C
20. Topic: Alzheimer's Disease
Subject: Medicine
Which one of the following tests is most useful for the initial workup of suspected Alzheimers disease?
A. Carotid Doppler ultrasonography
B. An erythrocyte sedimentation rate
C. A cardiac stress test
D. A TSH level
Answer : D
Subject: Medicine
Which one of the following tests is most useful for the initial workup of suspected Alzheimers disease?
A. Carotid Doppler ultrasonography
B. An erythrocyte sedimentation rate
C. A cardiac stress test
D. A TSH level
Answer : D
21. Topic: Essential Tremor
Subject: Medicine
A 66 year old white female consults you because she has developed a tremor of her right hand that interferes with her ability to do needlework. She has noticed that the tremor improves when she rests her hands in her lap and gets worse when she holds them up against gravity. She has developed a slight quiver to her voice as well. Her symptoms started gradually over 6 months ago and have progressed slowly. She remembers her mother having similar problems in her later years. She takes no medications, and her physical examination corroborates her history. No other abnormalities are noted. A multiple chemistry screen and TSH level are normal.
Which one of the following is most likely to alleviate her tremor?
A. Propranolol (Inderal)
B. Paroxetine (Paxil)
C. Carbidopa/levodopa (Sinemet)
D. Bromocriptine (Parlodel)
Answer : A
Subject: Medicine
A 66 year old white female consults you because she has developed a tremor of her right hand that interferes with her ability to do needlework. She has noticed that the tremor improves when she rests her hands in her lap and gets worse when she holds them up against gravity. She has developed a slight quiver to her voice as well. Her symptoms started gradually over 6 months ago and have progressed slowly. She remembers her mother having similar problems in her later years. She takes no medications, and her physical examination corroborates her history. No other abnormalities are noted. A multiple chemistry screen and TSH level are normal.
Which one of the following is most likely to alleviate her tremor?
A. Propranolol (Inderal)
B. Paroxetine (Paxil)
C. Carbidopa/levodopa (Sinemet)
D. Bromocriptine (Parlodel)
Answer : A
22. Topic: Normal Pressure Hydrocephalus
Subject: Medicine
A 76-year-old male is brought to your office by his son. The patient complains of dizziness that has slowly been worsening over the past year. His description is vague, but he says that he notices the dizziness when he tries to walk. The review of systems is normal, except for increasing problems with his prostate in the last 6 months, with dribbling and accidents at times. The patient admits to going more often, and sometimes without warning. The son states that his father seems more forgetful, slower of speech, and not as full of life as he used to be. A neurologic examination reveals the patient to be oriented x 3, with a somewhat flat affect and a wide-based, slow, shuffling gate. The examination is otherwise normal. His Mini-Mental State Examination (MMSE) score is 22 out of 30. No tremor is noted. A CBC, creatinine level, TSH level, vitamin B12 level and VDRL are all normal.
Which one of the following should you do next?
A. Order a brain MRI
B. Prescribe sertraline (Zoloft)
C. Prescribe carbidopa/levodopa (Sinemet)
D. Order physical therapy
Answer : A
Subject: Medicine
A 76-year-old male is brought to your office by his son. The patient complains of dizziness that has slowly been worsening over the past year. His description is vague, but he says that he notices the dizziness when he tries to walk. The review of systems is normal, except for increasing problems with his prostate in the last 6 months, with dribbling and accidents at times. The patient admits to going more often, and sometimes without warning. The son states that his father seems more forgetful, slower of speech, and not as full of life as he used to be. A neurologic examination reveals the patient to be oriented x 3, with a somewhat flat affect and a wide-based, slow, shuffling gate. The examination is otherwise normal. His Mini-Mental State Examination (MMSE) score is 22 out of 30. No tremor is noted. A CBC, creatinine level, TSH level, vitamin B12 level and VDRL are all normal.
Which one of the following should you do next?
A. Order a brain MRI
B. Prescribe sertraline (Zoloft)
C. Prescribe carbidopa/levodopa (Sinemet)
D. Order physical therapy
Answer : A
23. Topic: Amnesia
Subject: Medicine
Which of the following medications may cause amnesia as a side effet?
A. Hydroxyzine
B. Fluoxetine
C. Triazolam
D. Clonidine
Answer : C
Subject: Medicine
Which of the following medications may cause amnesia as a side effet?
A. Hydroxyzine
B. Fluoxetine
C. Triazolam
D. Clonidine
Answer : C
24. Topic: Subarachnoid Hemorrhage
Subject: Medicine
A 36-year-old female presents with the sudden onset of severe headache, nausea, and photophobia. Her level of consciousness is progressively diminishing. Which one of the following would be the most appropriate next step?
A. Head CT without contrast
B. Head CT with contrast
C. Head MRI
D. Lumbar puncture
Answer : A
Subject: Medicine
A 36-year-old female presents with the sudden onset of severe headache, nausea, and photophobia. Her level of consciousness is progressively diminishing. Which one of the following would be the most appropriate next step?
A. Head CT without contrast
B. Head CT with contrast
C. Head MRI
D. Lumbar puncture
Answer : A
25. Topic: Mini Mental Status Exam (or MMSE)
Subject: Medicine
While performing the Mini-Mental State Exam the PCP asks her patient to copy the following design. What cognitive function is being assessed by this request?
A. Language
B. Orientation
C. Registration
D. Visual-motor integrity
Answer : D
Subject: Medicine
While performing the Mini-Mental State Exam the PCP asks her patient to copy the following design. What cognitive function is being assessed by this request?
A. Language
B. Orientation
C. Registration
D. Visual-motor integrity
Answer : D
26. Topic: Huntington Chorea
Subject: Medicine
A patient previously diagnosed with Huntington chorea (HC) comes for a family planning consult with his wife. He states that his father had the disease and his mother was unaffected. They ask you what is the likelihood having a son with this condition?
A. Zero
B. 25%
C. 50%
D. 75%
Answer : B
Subject: Medicine
A patient previously diagnosed with Huntington chorea (HC) comes for a family planning consult with his wife. He states that his father had the disease and his mother was unaffected. They ask you what is the likelihood having a son with this condition?
A. Zero
B. 25%
C. 50%
D. 75%
Answer : B
27. Topic: Brown-Sequard Syndrome
Subject: Medicine
Which of the following would not be expected in a right-sided Brown-S�quard syndrome?
A. Right-sided hemi-paresis
B. Right-sided loss of proprioception
C. Left-sided decreased sensitivity to pinprick
D. Left-sided decreased vibration sense
Answer : D
Subject: Medicine
Which of the following would not be expected in a right-sided Brown-S�quard syndrome?
A. Right-sided hemi-paresis
B. Right-sided loss of proprioception
C. Left-sided decreased sensitivity to pinprick
D. Left-sided decreased vibration sense
Answer : D
28. Topic: MMSE
Subject: Medicine
The Mini-Mental State Examination (MMSE) tests for:
A. Mood
B. Behavior
C. Intelligence quotient
D. Cognitive function
Answer : D
Subject: Medicine
The Mini-Mental State Examination (MMSE) tests for:
A. Mood
B. Behavior
C. Intelligence quotient
D. Cognitive function
Answer : D
29. Topic: Status Epilepticus
Subject: Medicine
Which one of the following should be given intravenously in the initial treatment of status epilepticus?
A. Propofol (Diprivan)
B. Phenobarbital
C. Lorazepam (Ativan)
D. Midazolam (Versed)
Answer : C
Subject: Medicine
Which one of the following should be given intravenously in the initial treatment of status epilepticus?
A. Propofol (Diprivan)
B. Phenobarbital
C. Lorazepam (Ativan)
D. Midazolam (Versed)
Answer : C
30. Topic: Absence Seizures
Subject: Medicine
The treatment of choice for absence seizures is:
A. Lamotrigine
B. Ethosuximide
C. Phenobarbital
D. Phenytoin
Answer : B
Subject: Medicine
The treatment of choice for absence seizures is:
A. Lamotrigine
B. Ethosuximide
C. Phenobarbital
D. Phenytoin
Answer : B
31. Topic: Dementia
Subject: Medicine
An 85 year old white male is brought to you for the first time by his son. The father has recently seen a neurologist who performed a workup for dementia and diagnosed moderate Alzheimers disease. Which one of the following is true regarding the use of a cholinesterase inhibitor in this patient?
A. It is too late to initiate cholinesterase therapy
B. Agitation is often intensified by these agents
C. Memory is likely to improve significantly
D. Nursing-home placement may be delayed a year or longer
Answer : D
Subject: Medicine
An 85 year old white male is brought to you for the first time by his son. The father has recently seen a neurologist who performed a workup for dementia and diagnosed moderate Alzheimers disease. Which one of the following is true regarding the use of a cholinesterase inhibitor in this patient?
A. It is too late to initiate cholinesterase therapy
B. Agitation is often intensified by these agents
C. Memory is likely to improve significantly
D. Nursing-home placement may be delayed a year or longer
Answer : D
32. Topic: Status Epilepticus
Subject: Medicine
A 58-year-old male with a history of seizure attacks suffered from a 30min loss of consciousness with repetitive seizures with no recovery of consciousness between attacks. What is the best initial treatment for his condition?
A. Lorazepam
B. Phenytoin
C. Phenobarbital
D. Carbamazepine
Answer : A
Subject: Medicine
A 58-year-old male with a history of seizure attacks suffered from a 30min loss of consciousness with repetitive seizures with no recovery of consciousness between attacks. What is the best initial treatment for his condition?
A. Lorazepam
B. Phenytoin
C. Phenobarbital
D. Carbamazepine
Answer : A
33. Topic: Mini Mental Status Exam (or MMSE)
Subject: Medicine
In healthy adults, performance on the Folstein Mini-Mental State Examination is affected by which one of the following?
A. Educational attainment
B. Socioeconomic status
C. Gender
D. Race
Answer : A
Subject: Medicine
In healthy adults, performance on the Folstein Mini-Mental State Examination is affected by which one of the following?
A. Educational attainment
B. Socioeconomic status
C. Gender
D. Race
Answer : A
34. Topic: Seizure
Subject: Medicine
A 52-year-old male with a history of seizure attacks suffered from loss of consciousness and tonic-clonic muscular contractions. His tongue fell back into his throat and he choked.
What is the medication of choice for the treatment of this patient's condition?
A. Phenytoin
B. Valproic acid
C. Tiagabine
D. Phenobarbital
Answer : B
Subject: Medicine
A 52-year-old male with a history of seizure attacks suffered from loss of consciousness and tonic-clonic muscular contractions. His tongue fell back into his throat and he choked.
What is the medication of choice for the treatment of this patient's condition?
A. Phenytoin
B. Valproic acid
C. Tiagabine
D. Phenobarbital
Answer : B
35. Topic: Temporal Arteritis
Subject: Medicine
A female patient complains of a severe headache and jaw pain when she chews. She also complains of shoulder pain and bilateral wrist weakness. Initial lab tests show an ESR of 75 (normal is less than 30).
What is the most appropriate diagnosis?
A. Rheumatoid Arthritis
B. Temporal Arteritis
C. Polymyositis
D. Sarcoidosis
Answer : B
Subject: Medicine
A female patient complains of a severe headache and jaw pain when she chews. She also complains of shoulder pain and bilateral wrist weakness. Initial lab tests show an ESR of 75 (normal is less than 30).
What is the most appropriate diagnosis?
A. Rheumatoid Arthritis
B. Temporal Arteritis
C. Polymyositis
D. Sarcoidosis
Answer : B
36. Topic: Dementia
Subject: Medicine
A 60-year-old white female presents for her annual physical examination. She tells you that since her last visit she has begun taking ginkgo biloba to improve her memory. She takes no other medications. The evidence supporting a benefit from ginkgo biloba is best for which one of the following?
A. Tinnitus
B. Benign prostatic hyperplasia
C. Dementia
D. Intermittent claudication
Answer : C
Subject: Medicine
A 60-year-old white female presents for her annual physical examination. She tells you that since her last visit she has begun taking ginkgo biloba to improve her memory. She takes no other medications. The evidence supporting a benefit from ginkgo biloba is best for which one of the following?
A. Tinnitus
B. Benign prostatic hyperplasia
C. Dementia
D. Intermittent claudication
Answer : C
37. Topic: Seizure
Subject: Medicine
A 52-year-old man with a history of seizure attacks suffered from loss of consciousness and tonic and clonic muscular contractions. His tongue fell back into his throat and he choked. What is the best diagnostic test for assessment of the presenting condition of this patient?
A. X-rays
B. CT-Scan
C. Electroencephalogram
D. Discography
Answer : C
Subject: Medicine
A 52-year-old man with a history of seizure attacks suffered from loss of consciousness and tonic and clonic muscular contractions. His tongue fell back into his throat and he choked. What is the best diagnostic test for assessment of the presenting condition of this patient?
A. X-rays
B. CT-Scan
C. Electroencephalogram
D. Discography
Answer : C
38. Topic: Cholinergic Toxidrome
Subject: Medicine
A 37 year old male arrives at the Emergency Department unconscious. He is warm and sweaty. His heart rate is 52 bpm, his BP is 90/60. His pupils are constricted, his eyes are teary, and he is drooling. You assume he is suffering from a toxidrome.
What antidote will you give him?
A. Flumazenil
B. Naloxone
C. Glucagon
D. Atropine
Answer : D
Subject: Medicine
A 37 year old male arrives at the Emergency Department unconscious. He is warm and sweaty. His heart rate is 52 bpm, his BP is 90/60. His pupils are constricted, his eyes are teary, and he is drooling. You assume he is suffering from a toxidrome.
What antidote will you give him?
A. Flumazenil
B. Naloxone
C. Glucagon
D. Atropine
Answer : D
39. Topic: Horner's Syndome
Subject: Medicine
A 54-year-old white male presents with drooping of his right eyelid for 3 weeks. On examination, he has ptosis of the right upper lid, miosis of the right pupil, and decreased sweating on the right side of his face. Extraocular muscle movements are intact. In addition to a complete history and physical examination, which one of the following would be most appropriate at this point?
A. A chest radiograph
B. MRI of the brain and orbits
C. 131 Iodine thyroid scanning
D. A fasting blood glucose level
Answer : A
Subject: Medicine
A 54-year-old white male presents with drooping of his right eyelid for 3 weeks. On examination, he has ptosis of the right upper lid, miosis of the right pupil, and decreased sweating on the right side of his face. Extraocular muscle movements are intact. In addition to a complete history and physical examination, which one of the following would be most appropriate at this point?
A. A chest radiograph
B. MRI of the brain and orbits
C. 131 Iodine thyroid scanning
D. A fasting blood glucose level
Answer : A
40. Topic: Horner's Syndrome
Subject: Medicine
A 70-year-old man presented with ptosis, myosis and anhydrosis on the left side. Which one of the following is the most likely cause of this condition?
A. Tumour induced exophthalmos
B. Fourth cranial nerve palsy
C. Apical pulmonary carcinoma
D. Enlarged thyroid gland
Answer : C
Subject: Medicine
A 70-year-old man presented with ptosis, myosis and anhydrosis on the left side. Which one of the following is the most likely cause of this condition?
A. Tumour induced exophthalmos
B. Fourth cranial nerve palsy
C. Apical pulmonary carcinoma
D. Enlarged thyroid gland
Answer : C
41. Topic: Guillain-Barr� syndrome
Subject: Medicine
Guillain-Barr� syndrome is not associated with which of the following?
A. Proximal muscle weakness
B. Areflexia
C. Infection with C. jejuni
D. Treatment with corticosteroids
Answer : D
Subject: Medicine
Guillain-Barr� syndrome is not associated with which of the following?
A. Proximal muscle weakness
B. Areflexia
C. Infection with C. jejuni
D. Treatment with corticosteroids
Answer : D
42. Topic: Seizure
Subject: Medicine
A 32-year-old female experiences an episode of unresponsiveness associated with jerking movements of her arms and legs. Which one of the following presentations would make a diagnosis of true seizure more likely?
A. Post-event confusion
B. Eye closure during the event
C. A history of fibromyalgia
D. A history of chronic back pain
Answer : A
Subject: Medicine
A 32-year-old female experiences an episode of unresponsiveness associated with jerking movements of her arms and legs. Which one of the following presentations would make a diagnosis of true seizure more likely?
A. Post-event confusion
B. Eye closure during the event
C. A history of fibromyalgia
D. A history of chronic back pain
Answer : A
43. Topic: Postherpetic Neuralgia
Subject: Medicine
When given during acute herpes zoster (varicella) infection, which one of the following drugs has been shown to reduce the incidence of postherpetic neuralgia?
A. Imipramine (Tofranil)
B. Capsaicin (Zostrix)
C. Amitriptyline
D. Acyclovir (Zovirax)
Answer : D
Subject: Medicine
When given during acute herpes zoster (varicella) infection, which one of the following drugs has been shown to reduce the incidence of postherpetic neuralgia?
A. Imipramine (Tofranil)
B. Capsaicin (Zostrix)
C. Amitriptyline
D. Acyclovir (Zovirax)
Answer : D
44. Topic: Organophosphate poisoning
Subject: Medicine
What is the mechanism of action in organophosphate poisoning?
A. Cholinesterase inhibition
B. Cholinesterase activation
C. Catecholamine inhibition
D. Catecholamine activation
Answer : A
Subject: Medicine
What is the mechanism of action in organophosphate poisoning?
A. Cholinesterase inhibition
B. Cholinesterase activation
C. Catecholamine inhibition
D. Catecholamine activation
Answer : A
45. Topic: Seizure
Subject: Medicine
A patient is on carbamazepine for his new onset seizures. He has now had 3 attacks in last 2 weeks. His serum level of carbamazepine is within the therapeutic range.
What is the next step in management?
A. Repeat CT scan and EEG
B. Add another agent (eg. Phenytoin)
C. Re-check carbamazepine level in 2 weeks
D. Check CBC, CMP and TSH/FT4
Answer : B
Subject: Medicine
A patient is on carbamazepine for his new onset seizures. He has now had 3 attacks in last 2 weeks. His serum level of carbamazepine is within the therapeutic range.
What is the next step in management?
A. Repeat CT scan and EEG
B. Add another agent (eg. Phenytoin)
C. Re-check carbamazepine level in 2 weeks
D. Check CBC, CMP and TSH/FT4
Answer : B
46. Topic: Brain Death
Subject: Medicine
A 30 year old man has been on life support systems for the past 48 hours following blunt head trauma. Brain death cannot be established in this patient if there is the presence of which of the following?
A. Carotid blood flow
B. Cremasteric reflexes
C. Elevated serum aminoglycoside concentrations
D. Hypothermia
Answer : D
Subject: Medicine
A 30 year old man has been on life support systems for the past 48 hours following blunt head trauma. Brain death cannot be established in this patient if there is the presence of which of the following?
A. Carotid blood flow
B. Cremasteric reflexes
C. Elevated serum aminoglycoside concentrations
D. Hypothermia
Answer : D
47. Topic: Bell's Palsy
Subject: Medicine
A 53-year-old male accountant comes to your office with progressive facial weakness on the left side that began yesterday. He also reports pain behind the left ear and decreased lacrimation from the left eye. He has been in good health and had his yearly physical examination 1 week ago, which was normal. His lipid levels, chemistry profile, and CBC were all normal. He has not been involved in any outdoor activities, nor does he engage in any high-risk sexual behavior. On examination, there is flattening of the left nasolabial fold and decreased ability to close the left eye. The mouth appears to be drawn to the right. The remainder of his general examination and neurologic examination are normal.
Which one of the following would be the most appropriate management at this time?
A. Carotid ultrasonography
B. High-resolution CT
C. MRI with gadolinium enhancement
D. Prednisone and valacyclovir (Valtrex)
Answer : D
Subject: Medicine
A 53-year-old male accountant comes to your office with progressive facial weakness on the left side that began yesterday. He also reports pain behind the left ear and decreased lacrimation from the left eye. He has been in good health and had his yearly physical examination 1 week ago, which was normal. His lipid levels, chemistry profile, and CBC were all normal. He has not been involved in any outdoor activities, nor does he engage in any high-risk sexual behavior. On examination, there is flattening of the left nasolabial fold and decreased ability to close the left eye. The mouth appears to be drawn to the right. The remainder of his general examination and neurologic examination are normal.
Which one of the following would be the most appropriate management at this time?
A. Carotid ultrasonography
B. High-resolution CT
C. MRI with gadolinium enhancement
D. Prednisone and valacyclovir (Valtrex)
Answer : D
48. Topic: DM neuropathy
Subject: Medicine
In which of the following diseases would you see a gloves and stocking neuropathy?
A. Diabetes mellitus
B. Lupus
C. Multiple sclerosis
D. ALS
Answer : A
Subject: Medicine
In which of the following diseases would you see a gloves and stocking neuropathy?
A. Diabetes mellitus
B. Lupus
C. Multiple sclerosis
D. ALS
Answer : A
49. Topic: Temporal Lobe Lesion
Subject: Medicine
A 40 year old man presents with sporadically occurring behaviour automatisms and olfactory hallucinations. Which one of the following is the most likely diagnosis?
A. Schizophrenia
B. Schizophreniform psychosis
C. Hysterical personality disorder
D. Temporal lobe lesion
Answer : D
Subject: Medicine
A 40 year old man presents with sporadically occurring behaviour automatisms and olfactory hallucinations. Which one of the following is the most likely diagnosis?
A. Schizophrenia
B. Schizophreniform psychosis
C. Hysterical personality disorder
D. Temporal lobe lesion
Answer : D
50. Topic: Dementia
Subject: Medicine
All of the following dementias can benefit from specific treatments, except:
A. Normal pressure hydrocephalus (NPH)
B. Alzheimers disease
C. Sarcoidosis
D. Creutzfeldt Jakob disease
Answer : D
Subject: Medicine
All of the following dementias can benefit from specific treatments, except:
A. Normal pressure hydrocephalus (NPH)
B. Alzheimers disease
C. Sarcoidosis
D. Creutzfeldt Jakob disease
Answer : D
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