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)
Paroxetine (Paxil)
Carbidopa/levodopa (Sinemet)
Bromocriptine (Parlodel)
Correct Answer :
A. Propranolol (Inderal)
This patient has essential tremor, which is frequently a familial condition. Primidone and propranolol are the drugs most likely to provide relief of essential tremor. Other Beta-blockers such as atenolol and metroprolol may not be as effective, although results of trials are mixed. Antiparkinsonian medications such as carbidopa and bromocriptine have no effect on essential tremor. Carbamazepine is occasionally useful, but is much less likely to be effective than primidone.
Related Questions
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: 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?
Daily metformin compliance
Metoclopramide
Pregabalin
Alpha lipoic acid
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: 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: 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: DM neuropathy
Subject: Medicine
In which of the following diseases would you see a gloves and stocking neuropathy?
Diabetes mellitus
Lupus
Multiple sclerosis
ALS
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: Dementia
Subject: Medicine
Clinical features of multi-infarct dementia may include all of the following, except:
Parkinsonism
Deteriorating course
Evidence of cerebrovascular disease
Focal neurologic signs
Topic: Korsakoff's Psychosis
Subject: Medicine
In a patient with recent onset of alcohol amnestic disorder, the mental status test most likely to be done poorly is memory of:
Political figures of 10 years ago
Digits (forward)
His own name
Three items for 5 minutes
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?
Isoniazid
Diazepam
Primidone
Clonidine
Topic: Temporal Lobe Lesion
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
Temporal lobe lesion
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: 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?
Tinnitus
Benign prostatic hyperplasia
Dementia
Intermittent claudication
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
Order x-ray films of the cervical spine
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: Organophosphate poisoning
Subject: Medicine
What is the mechanism of action in organophosphate poisoning?
Cholinesterase inhibition
Cholinesterase activation
Catecholamine inhibition
Catecholamine activation
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: 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: 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
Guillain-Barr� syndrome is not associated with which of the following?
Proximal muscle weakness
Areflexia
Infection with C. jejuni
Treatment with corticosteroids
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: Absence Seizures
Subject: Medicine
The treatment of choice for absence seizures is:
Lamotrigine
Ethosuximide
Phenobarbital
Phenytoin
Topic: Fragile X Syndrome
Subject: Medicine
You are asked to see a mentally challenged 45-yearold male from a nearby group home who has groin pain. On examination you notice that he has large ears, a prominent jaw, and large symmetric testicles.
These findings are consistent with:
A variant form of Down syndrome
Aspergers syndrome
Klinefelters syndrome
Fragile X syndrome
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
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: Osmotic Demyelination
Subject: Medicine
Osmotic demyelination can result when which one of the following is corrected too rapidly?
Hypocalcemia
Hypoglycemia
Hypomagnesemia
Hyponatremia
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: Huntington Chorea
Subject: Medicine
A patient previously diagnosed with Huntington chorea (HC) comes for a family planning consult with his wife. He states that his father had the disease and his mother was unaffected. They ask you what is the likelihood having a son with this condition?
Zero
25%
50%
75%
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: 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