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Current Affairs January 2024

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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

Correct Answer :

A. Guillain-Barr� syndrome


Guillain-Barr� syndrome is the most common acquired inflammatory neuropathy. It is an acute, usually rapidly progressive inflammatory polyneuropathy characterized by muscular weakness and mild distal sensory loss. In most patients, the syndrome begins 1-3 weeks after an infectious disorder, surgery, or vaccination. Infection is the trigger in > 50% of patients, common pathogens include Campylobacter jejuni, enteric viruses, herpesviruses, and Mycoplasma. Flaccid weakness predominates in most patients, it is always more prominent than sensory abnormalities and may be most prominent proximally. Relatively symmetric weakness with paresthesias usually begins in the legs and progresses to the arms, but it occasionally begins in the arms or head. Diagnosis is clinical. If Guillain-Barr� syndrome is suspected, patients should be admitted to a hospital for electromyography (EMG), CSF analysis, and measurement of forced vital capacity. Guillain-Barr� syndrome is a medical emergency, requiring constant monitoring and support of vital functions, typically in an ICU. Plasmapheresis helps when done early in the syndrome and is the treatment of choice in acutely ill patients. Immune globulin is also effective when given early.

Related Questions

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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

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4

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?

A. Cerebral vascular disease

B. Hydrocephalus

C. Huntington's disease

D. Alzheimer's disease

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4

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?

A. Anticonvulsants

B. Aspirin

C. Nonsteroidal anti-inflammatory drugs

D. Vasoconstrictors

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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: 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

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4

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?

A. Clopidogrel (Plavix)

B. High-dose corticosteroids

C. NSAIDs

D. Dipyridamole/aspirin (Aggrenox)

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4

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?

A. Lorazepam

B. Phenytoin

C. Phenobarbital

D. Carbamazepine

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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: Benign Positional Vertigo
Subject: Medicine
Which one of the following is characteristic of benign positional vertigo?

A. A duration of 10-15 minutes

B. Associated hearing loss and tinnitus

C. Associated diplopia and facial numbness

D. Being triggered by turning the head

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4

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?

A. Serum dopamine levels

B. Computed tomography scan

C. Positron emission tomography scan

D. Magnetic resonance imaging

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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)

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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: 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

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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: Delirium Tremens
Subject: Medicine
A patient with delirium tremens manifests all of the following, except:

A. Clouded consciousness

B. Hypothermia

C. Coarse tremor

D. Tachypnea

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4

Topic: Guillain-Barr� syndrome
Subject: Medicine
Guillain-Barr� syndrome is not associated with which of the following?

A. Proximal muscle weakness

B. Areflexia

C. Infection with C. jejuni

D. Treatment with corticosteroids

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4

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?

A. Flumazenil

B. Naloxone

C. Glucagon

D. Atropine

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4

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?

A. Schizophrenia

B. Schizophreniform psychosis

C. Hysterical personality disorder

D. Temporal lobe lesion

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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)

What is the correct answer?

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

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: 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: 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?

A. Migraine headache

B. Premenstrual headache

C. Tension headache

D. Cluster headache

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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

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4

Topic: Absence Seizures
Subject: Medicine
The treatment of choice for absence seizures is:

A. Lamotrigine

B. Ethosuximide

C. Phenobarbital

D. Phenytoin

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4

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?

A. Famiciclovir (Famvir)

B. Prednisone

C. Capsaicin (Zostrix)

D. Carbamazepine (Tegretol)

What is the correct answer?

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%

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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: Alzheimer's Disease
Subject: Medicine
Which one of the following is most predictive of the progression from mild cognitive impairment to frank Alzheimers dementia?

A. Self-reported memory deficits

B. Memory deficits reported by a family member

C. A normal MRI scan of the brain

D. The absence of the apolipoprotein E4 allele

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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