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Current Affairs January 2024

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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

Correct Answer :

A. Educational attainment


The Mini-Mental State Examination, developed by Folstein in 1975, has become a standard tool for rapid clinical assessment of cognitive impairment. The score is known to be affected by the patients educational attainment. given the same level of cognitive impairment, those with higher education levels score somewhat better than those with less education. Race, sex, and socioeconomic status per se do not affect patients scores.

Related Questions

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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: Delirium Tremens
Subject: Medicine
You see a 49-year-old man in the emergency room with a 20-year-history of alcohol abuse. He is agitated and floridly psychotic, with visual hallucinations and persecutory delusions. On examination his blood pressure, heart rate and respiratory rate are all increased. He is disoriented, sweaty, and has abdominal cramps.
What is the most likely diagnosis?

A. Subdural hematoma

B. Alcohol intoxication

C. Hepatic encephalopathy

D. Delirium tremens

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4

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:

A. Political figures of 10 years ago

B. Digits (forward)

C. His own name

D. Three items for 5 minutes

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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

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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

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4

Topic: Normal Pressure Hydrocephalus
Subject: Medicine
A previously alert, otherwise healthy 74-year-old black male has a history of slowly developing progressive memory loss and dementia associated with urinary incontinence and gait disturbance resembling ataxia.
This presentation is most consistent with:

A. Normal pressure hydrocephalus

B. Alzheimers disease

C. Subacute sclerosing panencephalitis

D. Multiple sclerosis

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4

Topic: Osmotic Demyelination
Subject: Medicine
Osmotic demyelination can result when which one of the following is corrected too rapidly?

A. Hypocalcemia

B. Hypoglycemia

C. Hypomagnesemia

D. Hyponatremia

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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: 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: Temporal Arteritis
Subject: Medicine
A female patient complains of a severe headache and jaw pain when she chews. She also complains of shoulder pain and bilateral wrist weakness. Initial lab tests show an ESR of 75 (normal is less than 30).
What is the most appropriate diagnosis?

A. Rheumatoid Arthritis

B. Temporal Arteritis

C. Polymyositis

D. Sarcoidosis

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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: 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: 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: 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

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

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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: 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: 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: 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: 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: 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: 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: 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

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

What is the correct answer?

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

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: 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: 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: 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