Home
Current Affairs January 2024

What is the correct answer?

4

Topic: Mini Mental Status Exam (or MMSE)
Subject: Medicine
While performing the Mini-Mental State Exam the PCP asks her patient to copy the following design. What cognitive function is being assessed by this request?

A. Language

B. Orientation

C. Registration

D. Visual-motor integrity

Correct Answer :

D. Visual-motor integrity


While each possible choice listed is assessed during the Mini-Mental State Exam, the specific request to copy the given design screens for visual-motor integrity. A correct response includes correctly copying all ten angles, two of which must intersect. The correct response is awarded a score of 1 point on this 30-point screening exam.

Related Questions

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

A. Mood

B. Behavior

C. Intelligence quotient

D. Cognitive function

What is the correct answer?

4

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?

A. Yellow-orange cerebrospinal fluid supernatant

B. A WBC:RBC ratio of 1/1000

C. A protein (g/L) to RBC (count/L) of 1/1000

D. A glucose level below 2.2 mmol/L

What is the correct answer?

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

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 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

What is the correct answer?

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

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: 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: 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

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: 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: 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

What is the correct answer?

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

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
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)

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: 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

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: 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: 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: 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: 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: 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

What is the correct answer?

4

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?

A. Salsalate (Disalcid)

B. Celecoxib (Celebrex)

C. Hydrocodone (Lortab)

D. Tramadol (Ultram)

What is the correct answer?

4

Topic: Seizure
Subject: Medicine
Of the following, which is the most frequent cause of seizures in the elderly?

A. Alcohol withdrawal

B. Stroke

C. Head trauma

D. Hypoglycemia