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?
Subdural hematoma
Alcohol intoxication
Hepatic encephalopathy
Delirium tremens
Correct Answer :
D. Delirium tremens
Delirium tremens (DTs), a very serious set of symptoms, may result if alcohol withdrawal is left untreated. Delirium tremens usually does not begin immediately; rather, it appears about 2 to 10 days after the drinking stops. In delirium tremens, the person is initially anxious and later develops increasing confusion, sleeplessness, nightmares, excessive sweating, and profound depression. The pulse rate tends to speed up. Fever typically develops.
The episode may escalate to include fleeting hallucinations, illusions that arouse fear and restlessness, and disorientation with visual hallucinations that may incite terror. Objects seen in dim light may be particularly terrifying, and the person becomes extremely confused. The floor may seem to move, the walls fall, or the room rotates. As the delirium progresses, the hands develop a persistent tremor that sometimes extends to the head and body, and most people become severely uncoordinated. Delirium tremens can be fatal, particularly when untreated.
Related Questions
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Subject: Medicine
Which of the following medications may cause amnesia as a side effect?
Hydroxyzine
Fluoxetine
Triazolam
Clonidine
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
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Topic: Peripheral Neuropathy
Subject: Medicine
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Daily metformin compliance
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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
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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?
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Subject: Medicine
A 40 year old man presents with sporadically occurring behaviour automatisms and olfactory hallucinations. Which one of the following is the most likely diagnosis?
Schizophrenia
Schizophreniform psychosis
Hysterical personality disorder
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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?
Subdural hematoma
Alcohol intoxication
Hepatic encephalopathy
Delirium tremens
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?
Propranolol (Inderal)
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Carbidopa/levodopa (Sinemet)
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Subject: Medicine
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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?
Tinnitus
Benign prostatic hyperplasia
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Intermittent claudication
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
Dementia resulting from depression
Lewy body dementia
Multi-infarct dementia
Topic: Guillain-Barr� syndrome
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.
What is the most likely diagnosis?
Guillain-Barr� syndrome
Multiple Sclerosis
Myasthenia Gravis
Systemic Lupus Erythematosus
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?
Order a brain MRI
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Topic: Temporal Arteritis
Subject: Medicine
A 70-year-old woman returns to the office because of aching and weakness in her arms to the point where she cannot lift her arm to brush her hair. Physical examination shows no muscle tenderness or other evidence of joint disease in both arms. The aching improves when she takes the prescribed nonsteroidal anti-inflammatory drug (NSAID). She also describes tenderness over the right temporal area of her scalp. Physical examination of the scalp shows no lesions.
Which of the following is the most appropriate next step?
Increase the dose of the NSAID
Order determination of erythrocyte sedimentation rate
Order determination of serum rheumatoid factor
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Topic: Status Epilepticus
Subject: Medicine
A 58-year-old male with a history of seizure attacks suffered from a 30 min loss of consciousness with repetitive seizures with no recovery of consciousness between attacks. What is the disorder this patient is suffering from?
Tonic-clonic seizure
Absence seizure
Atonic seizure
Status epilepticus
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?
Levetiracetam
Phenytoin
Topiramate
Carbamazepine
Topic: Organophosphate poisoning
Subject: Medicine
What is the mechanism of action in organophosphate poisoning?
Cholinesterase inhibition
Cholinesterase activation
Catecholamine inhibition
Catecholamine activation
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: Brown-Sequard Syndrome
Subject: Medicine
Which of the following would not be expected in a right-sided Brown-S�quard syndrome?
Right-sided hemi-paresis
Right-sided loss of proprioception
Left-sided decreased sensitivity to pinprick
Left-sided decreased vibration sense
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:
Constipation
Tenderness
Abdominal distension
Decreased bowel sounds
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?
Repeat CT scan and EEG
Add another agent (eg. Phenytoin)
Re-check carbamazepine level in 2 weeks
Check CBC, CMP and TSH/FT4
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: 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?
Cerebral vascular disease
Hydrocephalus
Huntington's disease
Alzheimer's disease
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: 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?
Bedside EEG showing no electrical activity
Decorticate and decerebrate posturing
Failure to respond to electroconvulsive stimuli
Glasgow coma score of 3 or less
Topic: MMSE
Subject: Medicine
The Mini-Mental State Examination (MMSE) tests for:
Mood
Behavior
Intelligence quotient
Cognitive function
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?
Carotid blood flow
Cremasteric reflexes
Elevated serum aminoglycoside concentrations
Hypothermia
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?
Alprazolam (Xanax)
Clonazepam (Klonopin)
Carbamazepine (Tegretol)
Propranolol (Inderal)
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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: Delirium Tremens
Subject: Medicine
A patient with delirium tremens manifests all of the following, except:
Clouded consciousness
Hypothermia
Coarse tremor
Tachypnea