Home
Current Affairs January 2024

What is the correct answer?

4

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?

A. 11

B. 10

C. 9

D. 8

Correct Answer :

B. 10


The Glascow coma scale (GCS) is determined by assigning points to the following three questions: Eyes open: Spontaneously (4 points), to speech (3), to pain (2), none (1). Best verbal response: Orientated (5 points), confused (4), Inappropriate words and jumbled phrases consisting of words (3), incomprehensible sounds (2), none (1). Best motor response: Obeys commands (6 points), localizes pain (5), withdraws to pain (4), flexion (abnormal) to pain (3), extension to pain (2), none (1).
This patient has scores of 3, 3 and 4 to the three questions respectively, making his GCS score 10.

Related Questions

What is the correct answer?

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

What is the correct answer?

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

What is the correct answer?

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

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: 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: 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: 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

What is the correct answer?

4

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?

A. 11

B. 10

C. 9

D. 8

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

What is the correct answer?

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

What is the correct answer?

4

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?

A. Foley catheterization

B. Hospitalization for intravenous antibiotics

C. Digital disimpaction of the rectum, and Fleet enemas until clear

D. MRI of the lumbosacral spine

What is the correct answer?

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: Horner's Syndrome
Subject: Medicine
A 66-year-old diabetic man presents with constriction of the pupil, drooping of the upper lid, and anhidrosis on the left. Which one of the following nerves is most likely involved?

A. Oculomotor

B. Sympathetic

C. Trochlear

D. Trigeminal

What is the correct answer?

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

What is the correct answer?

4

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?

A. CT of the head

B. Carotid ultrasonography

C. A CBC and complete metabolic profile

D. An EKG

What is the correct answer?

4

Topic: Alzheimer's Disease
Subject: Medicine
Which one of the following tests is most useful for the initial workup of suspected Alzheimers disease?

A. Carotid Doppler ultrasonography

B. An erythrocyte sedimentation rate

C. A cardiac stress test

D. A TSH level

What is the correct answer?

4

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?

A. Levodopa

B. Bromocriptine

C. Chlorpromazine

D. Pergolide

What is the correct answer?

4

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?

A. Levetiracetam

B. Phenytoin

C. Topiramate

D. Carbamazepine

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: 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

What is the correct answer?

4

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. A variant form of Down syndrome

B. Aspergers syndrome

C. Klinefelters syndrome

D. Fragile X syndrome

What is the correct answer?

4

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. A chest radiograph

B. MRI of the brain and orbits

C. 131 Iodine thyroid scanning

D. A fasting blood glucose level

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: 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

What is the correct answer?

4

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?

A. Daily metformin compliance

B. Metoclopramide

C. Pregabalin

D. Alpha lipoic acid

What is the correct answer?

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: 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)

What is the correct answer?

4

Topic: Trigeminal Neuralgia
Subject: Medicine
A man complains that recently when he shaves he has a shooting type of pain in his face. It happens once in a while and then goes away. You suspect trigeminal neuralgia.
What is the treatment of choice?

A. Fluoxetine

B. Prednisone

C. Acyclovir

D. Carbamazepine

What is the correct answer?

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

What is the correct answer?

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)