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
Correct Answer :
C. Positron emission tomography scan
The major neuropathologic findings in Parkinson disease are a loss of pigmented dopaminergic neurons in the substantia nigra and the presence of Lewy bodies.
The characteristic symptoms of moderate Parkinson's disease can be remembered with the acronym TRAP:
Positron emission tomography (PET) and single photon emission CT (SPECT) are useful diagnostic imaging studies.
The scan uses 18-flurodopa to measure dopamine neurons in the substantia nigra area of the brain. The symptoms of Parkinsons are caused by loss of the dopamine neuron. 18-flurodopa is injected into the patient and then the brain is scanned. The scan is very sensitive to the dopamine cells and many people with Parkinsons will have an abnormal PET scan.
Magnetic resonance imaging (MRI) and computed tomography (CT) scan are unremarkable in Parkinson disease. No laboratory biomarkers exist for Parkinson disease. Serum ceruloplasmin concentration is obtained as a screening test for Wilson disease.
Related Questions
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?
CT of the head
Carotid ultrasonography
A CBC and complete metabolic profile
An EKG
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: Temporal Arteritis
Subject: Medicine
A 75-year-old female presents with a 2-month history of bilateral headache, diffuse myalgias, and diplopia. On examination she has substantially diminished vision in her left eye, but no other neurologic findings. A moderately tender, cordlike structure is palpable just anterior to her ear and extending up to her lateral scalp. Blood tests show a markedly elevated erythrocyte sedimentation rate.
Which one of the following would be most appropriate at this point?
Clopidogrel (Plavix)
High-dose corticosteroids
NSAIDs
Dipyridamole/aspirin (Aggrenox)
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: 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: 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: 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?
T12
L1
L2
L4 - L5
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: 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?
Only their male children are at risk
If one child develops the disease, siblings are not at risk
All their children will inherit the disease
Each child has 50% risk of inheriting the disease
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: 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?
Flumazenil
Naloxone
Glucagon
Atropine
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: 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: 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?
Salsalate (Disalcid)
Celecoxib (Celebrex)
Hydrocodone (Lortab)
Tramadol (Ultram)
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 chest radiograph
MRI of the brain and orbits
131 Iodine thyroid scanning
A fasting blood glucose level
Topic: Alzheimer's Disease
Subject: Medicine
Which one of the following has NOT been identified as a risk factor for Alzheimer-type dementia (AD)?
Trisomy 18
Head trauma
Advanced age
Obesity and hypertension
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: 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: Guillain-Barr� syndrome
Subject: Medicine
Guillain-Barr� syndrome is not associated with which of the following?
Proximal muscle weakness
Areflexia
Infection with C. jejuni
Treatment with corticosteroids
Topic: Intracranial Hemorrhage
Subject: Medicine
The most significant risk factor for spontaneous intracerebral hemorrhage is:
Atrial fibrillation
Cigarette smoking
Excessive alcohol use
Hypertension
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: Cauda Equina Syndrome
Subject: Medicine
A 65-year-old male presents with a 1-month history of problems passing 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?
Foley catheterization
Hospitalization for intravenous antibiotics
Digital disimpaction of the rectum, and Fleet enemas until clear
MRI of the lumbosacral spine
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
Prescribe sertraline (Zoloft)
Prescribe carbidopa/levodopa (Sinemet)
Order physical therapy
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?
It is too late to initiate cholinesterase therapy
Agitation is often intensified by these agents
Memory is likely to improve significantly
Nursing-home placement may be delayed a year or longer
Topic: Delirium Tremens
Subject: Medicine
A patient with delirium tremens manifests all of the following, except:
Clouded consciousness
Hypothermia
Coarse tremor
Tachypnea
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: 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)
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: 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?
Migraine headache
Premenstrual headache
Tension headache
Cluster headache
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