Topic: Adverse Drug Effect
Subject: Medicine
Which one of the following is most associated with falls in older adults?
Diphenhydramine (Benadryl)
Atorvastatin (Lipitor)
Metformin (Glucophage)
Memantine (Namenda)
Correct Answer :
A. Diphenhydramine (Benadryl)
Certain classes of medications are frequently associated with falls in older adults. These classes include benzodiazepines, antidepressants, antipsychotics, antiepileptics, anticholinergics, sedative hypnotics, muscle relaxants, and cardiovascular medications. Diphenhydramine is an antihistamine with anticholinergic effect medications associated with falls in older adults. The other drugs listed are not in the higher-risk groups of medications.
Related Questions
Topic: Osmotic Demyelination
Subject: Medicine
Osmotic demyelination can result when which one of the following is corrected too rapidly?
Hypocalcemia
Hypoglycemia
Hypomagnesemia
Hyponatremia
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?
Monocular visual loss
Internuclear ophthalmoplegia
Headache
Apraxia of gait
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?
Levodopa
Bromocriptine
Chlorpromazine
Pergolide
Topic: Alzheimer's Disease
Subject: Medicine
Which one of the following is associated with an increased risk of developing Alzheimers disease?
A positive homozygous genotype for apolipoprotein E4
Elevated serum aluminum
Elevated serum alpha-tocopherol
Decreased serum Beta-carotene
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:
Phenytoin (Dilantin)
Fosphenytoin (Cerebyx)
Naloxone
Lorazepam (Ativan)
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?
Serum dopamine levels
Computed tomography scan
Positron emission tomography scan
Magnetic resonance imaging
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?
Phenytoin
Valproic acid
Tiagabine
Phenobarbital
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?
Anticonvulsants
Aspirin
Nonsteroidal anti-inflammatory drugs
Vasoconstrictors
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:
Normal pressure hydrocephalus
Alzheimers disease
Subacute sclerosing panencephalitis
Multiple sclerosis
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).
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Rheumatoid Arthritis
Temporal Arteritis
Polymyositis
Sarcoidosis
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?
Tumour induced exophthalmos
Fourth cranial nerve palsy
Apical pulmonary carcinoma
Enlarged thyroid gland
Topic: Seizure
Subject: Medicine
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Discontinue the phenytoin
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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?
Alzheimers disease
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Lewy body dementia
Multi-infarct dementia
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?
Tumour induced exophthalmos
Fourth cranial nerve palsy
Apical pulmonary carcinoma
Enlarged thyroid gland
Topic: Delirium Tremens
Subject: Medicine
A patient with delirium tremens manifests all of the following, except:
Clouded consciousness
Hypothermia
Coarse tremor
Tachypnea
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?
Severe anemia
Hepatic encephalopathy
Subarachnoid hemorrhage
Vitamin B12 deficiency
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?
Yellow-orange cerebrospinal fluid supernatant
A WBC:RBC ratio of 1/1000
A protein (g/L) to RBC (count/L) of 1/1000
A glucose level below 2.2 mmol/L
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?
Post-event confusion
Eye closure during the event
A history of fibromyalgia
A history of chronic back pain
Topic: Dementia
Subject: Medicine
All of the following dementias can benefit from specific treatments, except:
Normal pressure hydrocephalus (NPH)
Alzheimers disease
Sarcoidosis
Creutzfeldt Jakob disease
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?
Lorazepam
Phenytoin
Phenobarbital
Carbamazepine
Topic: Postherpetic Neuralgia
Subject: Medicine
A 78-year-old male comes to your office with a 3- day history of pain in the right side of his chest. The pain is described as burning and intense. Two days ago he noted a rash at that site. Examination reveals groups of vesicles on an erythematous base in a T-5 dermatome distribution on the right.
Which one of the following would be the most appropriate treatment to minimize the chance of post-herpetic neuralgia?
Famiciclovir (Famvir)
Prednisone
Capsaicin (Zostrix)
Carbamazepine (Tegretol)
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?
Self-reported memory deficits
Memory deficits reported by a family member
A normal MRI scan of the brain
The absence of the apolipoprotein E4 allele
Topic: Intracranial Hemorrhage
Subject: Medicine
The most significant risk factor for spontaneous intracerebral hemorrhage is:
Atrial fibrillation
Cigarette smoking
Excessive alcohol use
Hypertension
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?
Imipramine (Tofranil)
Capsaicin (Zostrix)
Amitriptyline
Acyclovir (Zovirax)
Topic: Benign Positional Vertigo
Subject: Medicine
Which one of the following is characteristic of benign positional vertigo?
A duration of 10-15 minutes
Associated hearing loss and tinnitus
Associated diplopia and facial numbness
Being triggered by turning the head
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?
11
10
9
8
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Subject: Medicine
A 43-year-old man presents 2 weeks after you see him for infectious diarrhea caused by C. jejuni. He has now developed bilateral proximal lower limb weakness and bilateral distal parasthesia and decreased ankle tendon reflex.
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Guillain-Barr� syndrome
Multiple Sclerosis
Myasthenia Gravis
Systemic Lupus Erythematosus
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?
Weight gain
Rash
Nausea and headache
Tardive dyskinesia
Topic: Seizure
Subject: Medicine
Of the following, which is the most frequent cause of seizures in the elderly?
Alcohol withdrawal
Stroke
Head trauma
Hypoglycemia
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?
Confusion
Sweating
His temperature
His heart rate