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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

Correct Answer :

E.


Foot drop can be associated with a variety of conditions such as dorsiflexor injuries, peripheral nerve injuries, stroke, neuropathies, drug toxicities, or diabetes. Often drop foot is caused by injury to the common peroneal nerve (also called common fibular nerve, peroneal nerve, external popliteal nerve, lateral popliteal nerve), which is derived from the dorsal branches of the fourth and fifth lumbar and the first and second sacral nerves. The common peroneal nerve branches from the sciatic nerve. It includes the deep and superficial peroneal branches. These nerves provide sensation to the anterior and lateral parts of the legs and to the top of the feet. Symptoms of common peroneal nerve injury (foot drop) may include:
Inability to point toes toward the body (dorsiflexion)
Pain
Weakness
Numbness (on the shin or top of the foot)
Loss of function of foot
High-stepping walk (called steppage gait or footdrop gait)

Related Questions

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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: MMSE
Subject: Medicine
The Mini-Mental State Examination (MMSE) tests for:

A. Mood

B. Behavior

C. Intelligence quotient

D. Cognitive function

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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: DM neuropathy
Subject: Medicine
In which of the following diseases would you see a gloves and stocking neuropathy?

A. Diabetes mellitus

B. Lupus

C. Multiple sclerosis

D. ALS

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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: 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?

A. Alzheimers disease

B. Dementia resulting from depression

C. Lewy body dementia

D. Multi-infarct dementia

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4

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?

A. Carotid blood flow

B. Cremasteric reflexes

C. Elevated serum aminoglycoside concentrations

D. Hypothermia

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4

Topic: Dementia
Subject: Medicine
Clinical features of multi-infarct dementia may include all of the following, except:

A. Parkinsonism

B. Deteriorating course

C. Evidence of cerebrovascular disease

D. Focal neurologic signs

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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: 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)

What is the correct answer?

4

Topic: Seizure
Subject: Medicine
A 52-year-old male with a history of seizure attacks suffered from loss of consciousness and tonic and clonic muscular contractions. His tongue fell back into the throat and he choked. What is the most likely diagnosis of this presentation?

A. Petit mal seizure

B. Grand mal seizure

C. Myoclonic seizure

D. Atonic seizure

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4

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?

A. Confusion

B. Sweating

C. His temperature

D. His heart rate

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4

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?

A. Monocular visual loss

B. Internuclear ophthalmoplegia

C. Headache

D. Apraxia of gait

What is the correct answer?

4

Topic: Subarachnoid Hemorrhage
Subject: Medicine
A 36-year-old female presents with the sudden onset of severe headache, nausea, and photophobia. Her level of consciousness is progressively diminishing. Which one of the following would be the most appropriate next step?

A. Head CT without contrast

B. Head CT with contrast

C. Head MRI

D. Lumbar puncture

What is the correct answer?

4

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?

A. Guillain-Barr� syndrome

B. Multiple Sclerosis

C. Myasthenia Gravis

D. Systemic Lupus Erythematosus

What is the correct answer?

4

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?

A. Alprazolam (Xanax)

B. Clonazepam (Klonopin)

C. Carbamazepine (Tegretol)

D. Propranolol (Inderal)

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4

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?

A. Post-event confusion

B. Eye closure during the event

C. A history of fibromyalgia

D. A history of chronic back pain

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4

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?

A. Phenytoin

B. Valproic acid

C. Tiagabine

D. Phenobarbital

What is the correct answer?

4

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

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4

Topic: Brain Death
Subject: Medicine
A 57-year-old white male with coronary artery disease suffered a cardiac arrest while jogging 10 days ago. He was resuscitated after 45 minutes but has remained unresponsive and on a ventilator since then.
Which one of the following is required to diagnose brain death in this patient?

A. Hypothermia

B. Continuous mechanical ventilation

C. The absence of spontaneous body movements

D. Electroencephalographic confirmation

What is the correct answer?

4

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?

A. Tonic-clonic seizure

B. Absence seizure

C. Atonic seizure

D. Status epilepticus

What is the correct answer?

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

What is the correct answer?

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

What is the correct answer?

4

Topic: Alzheimer's Disease
Subject: Medicine
Which one of the following has NOT been identified as a risk factor for Alzheimer-type dementia (AD)?

A. Trisomy 18

B. Head trauma

C. Advanced age

D. Obesity and hypertension

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4

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?

A. Zero

B. 25%

C. 50%

D. 75%

What is the correct answer?

4

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?

A. Increase the dose of the NSAID

B. Order determination of erythrocyte sedimentation rate

C. Order determination of serum rheumatoid factor

D. Order x-ray films of the cervical spine

What is the correct answer?

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: Adverse Drug Effect
Subject: Medicine
Which one of the following is most associated with falls in older adults?

A. Diphenhydramine (Benadryl)

B. Atorvastatin (Lipitor)

C. Metformin (Glucophage)

D. Memantine (Namenda)

What is the correct answer?

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

What is the correct answer?

4

Topic: Seizure
Subject: Medicine
A 75-year-old male is brought to your office 1 month after a stroke that involved the left anterior cerebral artery, manifested by leg weakness, initial incontinence, and slowness in mentation. He experienced seizure activity on the second day after his stroke, but this was controlled by phenytoin (Dilantin). He has improved significantly and is now ambulatory. His family states that he now has episodic confusion, sleepiness, and clumsiness, which is preceded by paresthesias and dizziness, although no tonicclonic activity has been noted. He remains very drowsy for several hours after these episodes. He was wearing a cardiac monitor during one episode, but it showed nothing remarkable. His phenytoin level is therapeutic, and a CBC, metabolic profile, and magnesium level are all normal.
Which one of the following would be the most appropriate next step?

A. Discontinue the phenytoin

B. Add phenobarbital to the phenytoin

C. Begin bupropion (Wellbutrin)

D. Begin lamotrigine (Lamictal)