Basics of Neurology 1000+ MCQ with answer for SSC JHT
Thursday 9th of March 2023
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1. 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
2. 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
3. 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
4. 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
5. 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
6. 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
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: 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
9. 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
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: Seizure
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.
Which of the following medications is contraindicated in this patient's treatment?
A. Levetiracetam
B. Phenytoin
C. Topiramate
D. Carbamazepine
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.
Which of the following medications is contraindicated in this patient's treatment?
A. Levetiracetam
B. Phenytoin
C. Topiramate
D. Carbamazepine
Answer : C
12. 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
13. 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 eurodegenerative 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 eurodegenerative 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
14. 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
15. 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
16. 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
17. 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
18. 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
19. 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
20. 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
21. 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
22. 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
23. 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
24. 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
25. 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
26. 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 atient?
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 atient?
A. X-rays
B. CT-Scan
C. Electroencephalogram
D. Discography
Answer : C
27. Topic: Intracranial Hemorrhage
Subject: Medicine
The most significant risk factor for spontaneous intracerebral hemorrhage is:
A. Atrial fibrillation
B. Cigarette smoking
C. Excessive alcohol use
D. Hypertension
Answer : D
Subject: Medicine
The most significant risk factor for spontaneous intracerebral hemorrhage is:
A. Atrial fibrillation
B. Cigarette smoking
C. Excessive alcohol use
D. Hypertension
Answer : D
28. 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
29. 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
30. 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
31. 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
32. 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
33. 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
34. 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
35. 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
36. 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
37. 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
38. Topic: Alzheimer's Disease
Subject: Medicine
Which one of the following has NOT been identified as a risk factor for Alzheimer-type dementia (AD)?
A. Trisomy 18
B. Head trauma
C. Advanced age
D. Obesity and hypertension
Answer : A
Subject: Medicine
Which one of the following has NOT been identified as a risk factor for Alzheimer-type dementia (AD)?
A. Trisomy 18
B. Head trauma
C. Advanced age
D. Obesity and hypertension
Answer : A
39. 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
40. 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. 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. Prednisone
C. Acyclovir
D. Carbamazepine
Answer : D
41. 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
42. 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
43. 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
44. 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
45. 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
46. 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
47. 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
48. 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
49. 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
50. 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
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