1000+ Basics of Neurology MCQ for RRB JE [Solved]
Thursday 9th of March 2023
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1. 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
2. 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
3. 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
4. Topic: Amnesia
Subject: Medicine
Which of the following medications may cause amnesia as a side effect?
A. Hydroxyzine
B. Fluoxetine
C. Triazolam
D. Clonidine
Answer : C
Subject: Medicine
Which of the following medications may cause amnesia as a side effect?
A. Hydroxyzine
B. Fluoxetine
C. Triazolam
D. Clonidine
Answer : C
5. 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
6. 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
7. Topic: Analgesics
Subject: Medicine
A 74-year-old black female has moderately severe pain due to osteoarthritis. However, she is also on medication for a seizure disorder. When choosing medications to manage her chronic pain, which one of the following should be used with caution because of her history of seizures?
A. Salsalate (Disalcid)
B. Celecoxib (Celebrex)
C. Hydrocodone (Lortab)
D. Tramadol (Ultram)
Answer : D
Subject: Medicine
A 74-year-old black female has moderately severe pain due to osteoarthritis. However, she is also on medication for a seizure disorder. When choosing medications to manage her chronic pain, which one of the following should be used with caution because of her history of seizures?
A. Salsalate (Disalcid)
B. Celecoxib (Celebrex)
C. Hydrocodone (Lortab)
D. Tramadol (Ultram)
Answer : D
8. 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
9. 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 : D
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 : D
10. Topic: Diagnostic Investigations
Subject: Medicine
A 50-year-old male is brought to the emergency department because of a syncopal episode. Prior to the episode, he felt bad for 30 minutes, then developed nausea followed by vomiting. During a second bout of vomiting he blacked out and fell to the floor. His wife did not observe any seizure activity, and he was unconscious only for a few seconds. His history is otherwise negative, his past medical history is unremarkable, and he currently takes no medications. A physical examination is normal.
Which one of the following would be the most helpful next step?
A. CT of the head
B. Carotid ultrasonography
C. A CBC and complete metabolic profile
D. An EKG
Answer : D
Subject: Medicine
A 50-year-old male is brought to the emergency department because of a syncopal episode. Prior to the episode, he felt bad for 30 minutes, then developed nausea followed by vomiting. During a second bout of vomiting he blacked out and fell to the floor. His wife did not observe any seizure activity, and he was unconscious only for a few seconds. His history is otherwise negative, his past medical history is unremarkable, and he currently takes no medications. A physical examination is normal.
Which one of the following would be the most helpful next step?
A. CT of the head
B. Carotid ultrasonography
C. A CBC and complete metabolic profile
D. An EKG
Answer : D
11. Topic: Peripheral Neuropathy
Subject: Medicine
A 68-year-old male presents to your department complaining of a very horrible sensation in his legs that started out 4 weeks ago as pins and needles tickling him but now has progressed and feels like being stabbed in his feet. He has started to use a walker because he feels that when he walks it feels like stepping on eggshells. The pain has not been responsive to acetaminophen and ibuprofen. The patients past medical history is significant for diabetes type II treated with metformin and glimepiride. The patient has not been very compliant with medications, especially metformin because he feels it causes him an upset stomach. His most recent HbA1C level was 9.8%. He also has hypercholesterolemia treated with lovastatin and hypertension treated with Lisinopril and amlodipine. His vital signs are temperature 37.4°C, BP is 125/70 mmHg, pulse 85/min, and respirations 15/min. The dorsalis pedis and posterior tibial pulses are +2 bilaterally. No distal muscles weakness or atrophy is observed. Manual esthesiometer with monofilaments is used and reveals decreased sensation from the midfoot distally on both feet. There is no evidence of erythema, edema, or any wounds on either foot. He has tenderness to light touch on both feet. Labs reveal normal Vitamin B12 and thyroid function.
Which of the following would be the most appropriate treatment for this patients pain?
A. Daily metformin compliance
B. Metoclopramide
C. Pregabalin
D. Alpha lipoic acid
Answer : C
Subject: Medicine
A 68-year-old male presents to your department complaining of a very horrible sensation in his legs that started out 4 weeks ago as pins and needles tickling him but now has progressed and feels like being stabbed in his feet. He has started to use a walker because he feels that when he walks it feels like stepping on eggshells. The pain has not been responsive to acetaminophen and ibuprofen. The patients past medical history is significant for diabetes type II treated with metformin and glimepiride. The patient has not been very compliant with medications, especially metformin because he feels it causes him an upset stomach. His most recent HbA1C level was 9.8%. He also has hypercholesterolemia treated with lovastatin and hypertension treated with Lisinopril and amlodipine. His vital signs are temperature 37.4°C, BP is 125/70 mmHg, pulse 85/min, and respirations 15/min. The dorsalis pedis and posterior tibial pulses are +2 bilaterally. No distal muscles weakness or atrophy is observed. Manual esthesiometer with monofilaments is used and reveals decreased sensation from the midfoot distally on both feet. There is no evidence of erythema, edema, or any wounds on either foot. He has tenderness to light touch on both feet. Labs reveal normal Vitamin B12 and thyroid function.
Which of the following would be the most appropriate treatment for this patients pain?
A. Daily metformin compliance
B. Metoclopramide
C. Pregabalin
D. Alpha lipoic acid
Answer : C
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: Brain Death
Subject: Medicine
A 35 year old man has been on life support systems for the past 48 hours following blunt head trauma. Which of the following is te most important criterion to declare the patient brain dead and to permit removal of life support systems?
A. Bedside EEG showing no electrical activity
B. Decorticate and decerebrate posturing
C. Failure to respond to electroconvulsive stimuli
D. Glasgow coma score of 3 or less
Answer : A
Subject: Medicine
A 35 year old man has been on life support systems for the past 48 hours following blunt head trauma. Which of the following is te most important criterion to declare the patient brain dead and to permit removal of life support systems?
A. Bedside EEG showing no electrical activity
B. Decorticate and decerebrate posturing
C. Failure to respond to electroconvulsive stimuli
D. Glasgow coma score of 3 or less
Answer : A
14. 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
15. 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
16. 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
17. Topic: Seizure
Subject: Medicine
A 36-year-old male with a history of a seizure disorder is brought to the emergency department with generalized tonic-clonic activity. Emergency medical personnel report this has been ongoing for 20 minutes.
After initial resuscitative measures, the preferred medication in this situation is:
A. Phenytoin (Dilantin)
B. Fosphenytoin (Cerebyx)
C. Naloxone
D. Lorazepam (Ativan)
Answer : D
Subject: Medicine
A 36-year-old male with a history of a seizure disorder is brought to the emergency department with generalized tonic-clonic activity. Emergency medical personnel report this has been ongoing for 20 minutes.
After initial resuscitative measures, the preferred medication in this situation is:
A. Phenytoin (Dilantin)
B. Fosphenytoin (Cerebyx)
C. Naloxone
D. Lorazepam (Ativan)
Answer : D
18. 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
19. 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
20. Topic: Alzheimer's Disease
Subject: Medicine
Which one of the following is associated with an increased risk of developing Alzheimers disease?
A. A positive homozygous genotype for apolipoprotein E4
B. Elevated serum aluminum
C. Elevated serum alpha-tocopherol
D. Decreased serum Beta-carotene
Answer : A
Subject: Medicine
Which one of the following is associated with an increased risk of developing Alzheimers disease?
A. A positive homozygous genotype for apolipoprotein E4
B. Elevated serum aluminum
C. Elevated serum alpha-tocopherol
D. Decreased serum Beta-carotene
Answer : A
21. 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
22. Topic: Alzheimer's Disease
Subject: Medicine
A 62 year old woman has demonstrated increasing loss of recent memory over a 5 year period, now associated with reduced affect and nominal dysphasia. She dresses neatly and social amenities are preserved. There are no localizing motor or sensory findings.
Which one of the following is the most likely diagnosis?
A. Cerebral vascular disease
B. Hydrocephalus
C. Huntington's disease
D. Alzheimer's disease
Answer : D
Subject: Medicine
A 62 year old woman has demonstrated increasing loss of recent memory over a 5 year period, now associated with reduced affect and nominal dysphasia. She dresses neatly and social amenities are preserved. There are no localizing motor or sensory findings.
Which one of the following is the most likely diagnosis?
A. Cerebral vascular disease
B. Hydrocephalus
C. Huntington's disease
D. Alzheimer's disease
Answer : D
23. 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
24. 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
25. 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
26. Topic: Heatstroke
Subject: Medicine
A 72-year-old male is brought to your office by a friend because of increasing confusion, irritability, and difficulty walking. This began shortly after the patients car broke down and he had to walk a mile to get to a phone and call the friend. The temperature outdoors has been near 39.5°C (100°F).
On examination you note a rectal temperature of 39.5°C (103.1°F). His pulse rate is 110 beats/min and his blood pressure is 100/60 mm Hg.
A. Confusion
B. Sweating
C. His temperature
D. His heart rate
Answer : A
Subject: Medicine
A 72-year-old male is brought to your office by a friend because of increasing confusion, irritability, and difficulty walking. This began shortly after the patients car broke down and he had to walk a mile to get to a phone and call the friend. The temperature outdoors has been near 39.5°C (100°F).
On examination you note a rectal temperature of 39.5°C (103.1°F). His pulse rate is 110 beats/min and his blood pressure is 100/60 mm Hg.
A. Confusion
B. Sweating
C. His temperature
D. His heart rate
Answer : A
27. 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
28. 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
29. Topic: Huntington disease
Subject: Medicine
A 42-year-old white male is brought to your department by his wife because of the progressive loss of his mental abilities, irritability, and some irregular involuntary movements of his hands. She says that she can remember when they were newlyweds, her husbands father had a similar condition at the age of 45 and he died few years later because there was not much doctors could do for him back then. She wants to know if their children may eventually develop a similar condition in the future. None in her family has ever had this type of condition. Which of the following would be the most appropriate answer?
A. Only their male children are at risk
B. If one child develops the disease, siblings are not at risk
C. All their children will inherit the disease
D. Each child has 50% risk of inheriting the disease
Answer : D
Subject: Medicine
A 42-year-old white male is brought to your department by his wife because of the progressive loss of his mental abilities, irritability, and some irregular involuntary movements of his hands. She says that she can remember when they were newlyweds, her husbands father had a similar condition at the age of 45 and he died few years later because there was not much doctors could do for him back then. She wants to know if their children may eventually develop a similar condition in the future. None in her family has ever had this type of condition. Which of the following would be the most appropriate answer?
A. Only their male children are at risk
B. If one child develops the disease, siblings are not at risk
C. All their children will inherit the disease
D. Each child has 50% risk of inheriting the disease
Answer : D
30. 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
31. 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
32. 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
33. 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
34. 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
35. Topic: Horner's Syndrome
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
36. 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
37. Topic: Trigeminal Neuralgia
Subject: Medicine
A man complains that recently when he shaves he has a shooting type of pain in his face. It happens once in a while and then goes away. You suspect trigeminal neuralgia.
What is the treatment of choice?
A. Fluoxetine
B./strong> Prednisone
C. Acyclovir
D. Carbamazepine
Answer : D
Subject: Medicine
A man complains that recently when he shaves he has a shooting type of pain in his face. It happens once in a while and then goes away. You suspect trigeminal neuralgia.
What is the treatment of choice?
A. Fluoxetine
B./strong> Prednisone
C. Acyclovir
D. Carbamazepine
Answer : D
38. Topic: Diagnostic Investigations
Subject: Medicine
A 52 year old male with a history of psychosis presents with muscle stiffness and resting tremors, associated with difficulty in balance and initiating movements. What is the best diagnostic method for detection of the above condition?
A. Serum dopamine levels
B. Computed tomography scan
C. Positron emission tomography scan
D. Magnetic resonance imaging
Answer : C
Subject: Medicine
A 52 year old male with a history of psychosis presents with muscle stiffness and resting tremors, associated with difficulty in balance and initiating movements. What is the best diagnostic method for detection of the above condition?
A. Serum dopamine levels
B. Computed tomography scan
C. Positron emission tomography scan
D. Magnetic resonance imaging
Answer : C
39. 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
40. Topic: Seizure
Subject: Medicine
A 75-year-old male is brought to your office 1 month after a stroke that involved the left anterior cerebral artery, manifested by leg weakness, initial incontinence, and slowness in mentation. He experienced seizure activity on the second day after his stroke, but this was controlled by phenytoin (Dilantin). He has improved significantly and is now ambulatory. His family states that he now has episodic confusion, sleepiness, and clumsiness, which is preceded by paresthesias and dizziness, although no tonicclonic activity has been noted. He remains very drowsy for several hours after these episodes. He was wearing a cardiac monitor during one episode, but it showed nothing remarkable. His phenytoin level is therapeutic, and a CBC, metabolic profile, and magnesium level are all normal.
Which one of the following would be the most appropriate next step?
A. Discontinue the phenytoin
B. Add phenobarbital to the phenytoin
C. Begin bupropion (Wellbutrin)
D. Begin lamotrigine (Lamictal)
Answer : D
Subject: Medicine
A 75-year-old male is brought to your office 1 month after a stroke that involved the left anterior cerebral artery, manifested by leg weakness, initial incontinence, and slowness in mentation. He experienced seizure activity on the second day after his stroke, but this was controlled by phenytoin (Dilantin). He has improved significantly and is now ambulatory. His family states that he now has episodic confusion, sleepiness, and clumsiness, which is preceded by paresthesias and dizziness, although no tonicclonic activity has been noted. He remains very drowsy for several hours after these episodes. He was wearing a cardiac monitor during one episode, but it showed nothing remarkable. His phenytoin level is therapeutic, and a CBC, metabolic profile, and magnesium level are all normal.
Which one of the following would be the most appropriate next step?
A. Discontinue the phenytoin
B. Add phenobarbital to the phenytoin
C. Begin bupropion (Wellbutrin)
D. Begin lamotrigine (Lamictal)
Answer : D
41. Topic: Essential Tremor
Subject: Medicine
Which one of the following is most likely to be of benefit in patients with essential tremor of the hand?
A. Isoniazid
B. Diazepam
C. Primidone
D. Clonidine
Answer : C
Subject: Medicine
Which one of the following is most likely to be of benefit in patients with essential tremor of the hand?
A. Isoniazid
B. Diazepam
C. Primidone
D. Clonidine
Answer : C
42. 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
43. Topic: Trigeminal Neuralgia
Subject: Medicine
A 55-year-old man complains of extremely severe, sharp, shooting pain in his face. He describes the episodes as being like a bolt of electricity that are brought about by touching a specific area, last about 60 seconds, and occur many times during the day. Neurologic examination is completely normal, but it is noted that part of his face is unshaven because he fears to touch that area. Gadoliniumenhanced MRI shows no abnormalities of the trigeminal nerve.
Which of the following is the most appropriate initial treatment?
A. Anticonvulsants
B. Aspirin
C. Nonsteroidal anti-inflammatory drugs
D. Vasoconstrictors
Answer : A
Subject: Medicine
A 55-year-old man complains of extremely severe, sharp, shooting pain in his face. He describes the episodes as being like a bolt of electricity that are brought about by touching a specific area, last about 60 seconds, and occur many times during the day. Neurologic examination is completely normal, but it is noted that part of his face is unshaven because he fears to touch that area. Gadoliniumenhanced MRI shows no abnormalities of the trigeminal nerve.
Which of the following is the most appropriate initial treatment?
A. Anticonvulsants
B. Aspirin
C. Nonsteroidal anti-inflammatory drugs
D. Vasoconstrictors
Answer : A
44. 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
45. 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
46. 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
47. 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
49. Topic: Hepatic Encephalopathy
Subject: Medicine
A 50-year-old man with a history of hemochromatosis presents to the emergency room vomiting up bright red blood. He had his most recent phlebotomy yesterday. His blood pressure is 110/85 mm Hg, his pulse 115/min; his face is flushed, and he is diaphoretic. During the physical examination splenomegaly and a venous pattern on his chest and abdomen are noted. He seems somewhat drowsy and confused but has no focal neurologic signs.
What is the probable source of this patient's confusion?
A. Severe anemia
B. Hepatic encephalopathy
C. Subarachnoid hemorrhage
D. Vitamin B12 deficiency
Answer : B
Subject: Medicine
A 50-year-old man with a history of hemochromatosis presents to the emergency room vomiting up bright red blood. He had his most recent phlebotomy yesterday. His blood pressure is 110/85 mm Hg, his pulse 115/min; his face is flushed, and he is diaphoretic. During the physical examination splenomegaly and a venous pattern on his chest and abdomen are noted. He seems somewhat drowsy and confused but has no focal neurologic signs.
What is the probable source of this patient's confusion?
A. Severe anemia
B. Hepatic encephalopathy
C. Subarachnoid hemorrhage
D. Vitamin B12 deficiency
Answer : B
50. 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
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