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Current Affairs January 2024

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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

Correct Answer :

D. Temporal lobe lesion


Olfactory hallucinations are related to lobe lesions throughout the entire brain, though mainly to the temporal lobe. Complex automatic behaviorisms are related to lesions of the temporal lobe.
Visual hallucinations (formed images) are related to lesions of the posterior temporal lobe or amygdala-hippocampus. Visual hallucinations (unformed images) are related to lesions of the occipital lobe.

Related Questions

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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

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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: 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: 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: 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: 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: 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: 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

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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

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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: 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

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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: 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: 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: 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

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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

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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: Dementia
Subject: Medicine
All of the following dementias can benefit from specific treatments, except:

A. Normal pressure hydrocephalus (NPH)

B. Alzheimers disease

C. Sarcoidosis

D. Creutzfeldt Jakob disease

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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: 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

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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)

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

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

A. Lamotrigine

B. Ethosuximide

C. Phenobarbital

D. Phenytoin

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%