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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

Correct Answer :

D. Left-sided decreased vibration sense


Brown-Sequard syndrome (BSS) is a rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side. In addition, loss of proprioception, spastic paralysis, and hyperactive deep tendon reflexes develop ipsilaterally (same side). BSS may be caused by a spinal cord tumor, trauma (such as a puncture wound to the neck or back), ischemia (obstruction of a blood vessel), or infectious or inflammatory diseases such as tuberculosis, or multiple sclerosis.
>Right-sided hemi-paresis (choice A), Right-sided loss of proprioception (choice B), and spasticity (choice E) all occur on the same side of the lesion.
> Left-sided decreased sensitivity to pinprick (choice C) ,which indicates pain, and loss of temperature sensation would both occur on the contralateral side.

Related Questions

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Topic: Guillain-Barr� syndrome
Subject: Medicine
Guillain-Barr� syndrome is not associated with which of the following?

A. Proximal muscle weakness

B. Areflexia

C. Infection with C. jejuni

D. Treatment with corticosteroids

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4

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

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4

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

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4

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

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4

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

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4

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

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4

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)

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4

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)

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4

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

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4

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)

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4

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

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4

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

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4

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

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4

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

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4

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)

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4

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

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4

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)

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4

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

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4

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

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4

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

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4

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

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4

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

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4

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

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4

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

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4

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

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4

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

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4

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

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4

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

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4

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

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4

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