Basics of Neurology 1000+ MCQ with answer for FCI Recruitment
Thursday 9th of March 2023
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1. 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
2. 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
3. Topic: Osmotic Demyelination
Subject: Medicine
Osmotic demyelination can result when which one of the following is corrected too rapidly?
A. Hypocalcemia
B. Hypoglycemia
C. Hypomagnesemia
D. Hyponatremia
Answer : D
Subject: Medicine
Osmotic demyelination can result when which one of the following is corrected too rapidly?
A. Hypocalcemia
B. Hypoglycemia
C. Hypomagnesemia
D. Hyponatremia
Answer : D
4. 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.
Which one of this patients findings indicates that he has heatstroke rather than heat exhaustion?
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.
Which one of this patients findings indicates that he has heatstroke rather than heat exhaustion?
A. Confusion
B. Sweating
C. His temperature
D. His heart rate
Answer : A
5. 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
6. 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
7. 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
8. 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
9. 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
10. Topic: Normal Pressure Hydrocephalus
Subject: Medicine
An 81-year-old female is brought to your office by her son. He reports a decrease in his mothers memory and prolonged delays in her responses to questions. She also has developed urinary incontinence. MRI shows dilated ventricles, but no other pathology, and a lumbar puncture reveals a normal opening pressure.
Which one of the following would provide additional evidence of normal pressure hydrocephalus?
A. Monocular visual loss
B. Internuclear ophthalmoplegia
C. Headache
D. Apraxia of gait
Answer : D
Subject: Medicine
An 81-year-old female is brought to your office by her son. He reports a decrease in his mothers memory and prolonged delays in her responses to questions. She also has developed urinary incontinence. MRI shows dilated ventricles, but no other pathology, and a lumbar puncture reveals a normal opening pressure.
Which one of the following would provide additional evidence of normal pressure hydrocephalus?
A. Monocular visual loss
B. Internuclear ophthalmoplegia
C. Headache
D. Apraxia of gait
Answer : D
11. Topic: Horner's Syndrome
Subject: Medicine
A 66-year-old diabetic man presents with constriction of the pupil, drooping of the upper lid, and anhidrosis on the left. Which one of the following nerves is most likely involved?
A. Oculomotor
B. Sympathetic
C. Trochlear
D. Trigeminal
Answer : B
Subject: Medicine
A 66-year-old diabetic man presents with constriction of the pupil, drooping of the upper lid, and anhidrosis on the left. Which one of the following nerves is most likely involved?
A. Oculomotor
B. Sympathetic
C. Trochlear
D. Trigeminal
Answer : B
12. 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. Emergencymedical 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. Emergencymedical 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
13. Topic: Mini Mental Status Exam (or MMSE)
Subject: Medicine
A 63-year-old retired teacher shared with his primary care physician (PCP) during a routine office visit that he has noticed increasing difficulty with his memory. Otherwise he is in good health and requiring no medication.
Which one of the following psychological tests is a valuable screening device to be used by primary care physicians in this type of situation?
A. MMPI
B. WAIS
C. Thematic Apperception Test
D. Mini-Mental State Exam
Answer : D
Subject: Medicine
A 63-year-old retired teacher shared with his primary care physician (PCP) during a routine office visit that he has noticed increasing difficulty with his memory. Otherwise he is in good health and requiring no medication.
Which one of the following psychological tests is a valuable screening device to be used by primary care physicians in this type of situation?
A. MMPI
B. WAIS
C. Thematic Apperception Test
D. Mini-Mental State Exam
Answer : D
14. 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
15. 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
16. 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
17. 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
18. 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
19. 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
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: 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
22. 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
23. 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
24. 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
25. 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 the 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 the 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
26. Topic: Amnesia
Subject: Medicine
Which of the following medications may cause amnesia as a side effect?
A. Hydroxyzine
strong>B. Fluoxetine
C. Triazolam
D. Clonidine
Answer : C
Subject: Medicine
Which of the following medications may cause amnesia as a side effect?
A. Hydroxyzine
strong>B. Fluoxetine
C. Triazolam
D. Clonidine
Answer : C
27. 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
28. 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
29. 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
30. Topic: Essential Tremor
Subject: Medicine
A 75 year old white male complains of a tremor which has been progressive over the past 2 years. The tremor interferes with writing, pouring liquids, and eating soup. He has no other medical problems. He abstains from alcohol and tobacco products. Physical examination is remarkable for an action tremor of the upper extremities and a head tremor. No rigidity or gait disorder is noted. Of the following agents, which one is most appropriate as initial drug therapy for this problem?
A. Alprazolam (Xanax)
B. Clonazepam (Klonopin)
C. Carbamazepine (Tegretol)
D. Propranolol (Inderal)
Answer : D
Subject: Medicine
A 75 year old white male complains of a tremor which has been progressive over the past 2 years. The tremor interferes with writing, pouring liquids, and eating soup. He has no other medical problems. He abstains from alcohol and tobacco products. Physical examination is remarkable for an action tremor of the upper extremities and a head tremor. No rigidity or gait disorder is noted. Of the following agents, which one is most appropriate as initial drug therapy for this problem?
A. Alprazolam (Xanax)
B. Clonazepam (Klonopin)
C. Carbamazepine (Tegretol)
D. Propranolol (Inderal)
Answer : D
31. 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
32. Topic: Foot Drop
Subject: Medicine
During the physical exam of a patients foot, you notice an inability to dorsiflex. What nerve root(s) is most likely affected?
A. T12
B. L1
C. L2
D. L4 - L5
Answer : E
Subject: Medicine
During the physical exam of a patients foot, you notice an inability to dorsiflex. What nerve root(s) is most likely affected?
A. T12
B. L1
C. L2
D. L4 - L5
Answer : E
33. Topic: Dementia
Subject: Medicine
Clinical features of multi-infarct dementia may include all of the following, except:
A. Parkinsonism
B. Deteriorating course
C. Evidence of cerebrovascular disease
D. Focal neurologic signs
Answer : A
Subject: Medicine
Clinical features of multi-infarct dementia may include all of the following, except:
A. Parkinsonism
B. Deteriorating course
C. Evidence of cerebrovascular disease
D. Focal neurologic signs
Answer : A
34. 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
35. 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
36. Topic: Adverse Drug Effect
Subject: Medicine
During the morning rounds, a second year resident presents a patient as a 58-year-old female who suffers from rigidity and tremors. She has been diagnosed with a neurodegenerative disease involving the depigmentation of substantia nigra and loss of dopaminergic input to basal ganglia. Identify the medication that would worsen rather than improve this patient's condition?
A. Levodopa
B. Bromocriptine
C. Chlorpromazine
D. Pergolide
Answer : C
Subject: Medicine
During the morning rounds, a second year resident presents a patient as a 58-year-old female who suffers from rigidity and tremors. She has been diagnosed with a neurodegenerative disease involving the depigmentation of substantia nigra and loss of dopaminergic input to basal ganglia. Identify the medication that would worsen rather than improve this patient's condition?
A. Levodopa
B. Bromocriptine
C. Chlorpromazine
D. Pergolide
Answer : C
37. Topic: Fragile X Syndrome
Subject: Medicine
You are asked to see a mentally challenged 45-yearold male from a nearby group home who has groin pain. On examination you notice that he has large ears, a prominent jaw, and large symmetric testicles.
These findings are consistent with:
A. A variant form of Down syndrome
B. Aspergers syndrome
C. Klinefelters syndrome
D. Fragile X syndrome
Answer : D
Subject: Medicine
You are asked to see a mentally challenged 45-yearold male from a nearby group home who has groin pain. On examination you notice that he has large ears, a prominent jaw, and large symmetric testicles.
These findings are consistent with:
A. A variant form of Down syndrome
B. Aspergers syndrome
C. Klinefelters syndrome
D. Fragile X syndrome
Answer : D
38. 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
39. 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
40. 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
41. Topic: Cauda Equina Syndrome
Subject: Medicine
A 65-year-old male presents with a 1-month history of problems passng 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 passng 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
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: 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
44. 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
45. 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
46. 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
47. 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
48. 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
49. 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
50. 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
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