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Current Affairs January 2024

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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)

Correct Answer :

D. Acyclovir (Zovirax)


A systematic review of 42 randomized, controlled trials showed that acyclovir reduced the incidence of postherpetic neuralgia at 3 months (number needed to treat = 3.2-8.0). Famciclovir was shown to reduce the duration of postherpetic pain. No conclusions could be drawn with regard to amitriptyline, narcotics, capsaicin, anticonvulsants, or percutaneous nerve stimulation. Studies examining these treatments were of fair to poor quality. Systemic corticosteroids showed no additional benefit.

Related Questions

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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: 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: 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: 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: Dementia
Subject: Medicine
A 60-year-old white female presents for her annual physical examination. She tells you that since her last visit she has begun taking ginkgo biloba to improve her memory. She takes no other medications. The evidence supporting a benefit from ginkgo biloba is best for which one of the following?

A. Tinnitus

B. Benign prostatic hyperplasia

C. Dementia

D. Intermittent claudication

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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: 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: 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: 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

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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

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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: Amnesia
Subject: Medicine
Which of the following medications may cause amnesia as a side effect?

A. Hydroxyzine

B. Fluoxetine

C. Triazolam

D. Clonidine

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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

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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

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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

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4

Topic: Alzheimer's Disease
Subject: Medicine
Which one of the following is associated with an increased risk of developing Alzheimers disease?

A. A positive homozygous genotype for apolipoprotein E4

B. Elevated serum aluminum

C. Elevated serum alpha-tocopherol

D. Decreased serum Beta-carotene

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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)

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4

Topic: Mini Mental Status Exam (or MMSE)
Subject: Medicine
A 63-year-old retired teacher shared with his primary care physician (PCP) during a routine office visit that he has noticed increasing difficulty with his memory. Otherwise he is in good health and requiring no medication.
Which one of the following psychological tests is a valuable screening device to be used by primary care physicians in this type of situation?

A. MMPI

B. WAIS

C. Thematic Apperception Test

D. Mini-Mental State Exam

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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: 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: 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: 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

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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: 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: 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: 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: 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 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: 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