Block 13 Pace 1 Prt 1

23 Questions | By Chachelly | Last updated: Mar 19, 2022 | Total Attempts: 375

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1.

An 18-year-old woman presents to the University’s clinic with a behavioral problem. She must get up at 5 a.m. in the morning to get to her first class in time. However, the time needed is expanding and she is now missing her class. She must go through a ritual of dressing, packing her books and going through doors and down steps that is taking more and more time. She has always had to be meticulous to get things done right, but she is now facing the fact that she cannot control it. Besides CBT, what is the best pharmacotherapy a physician might prescribe for this condition?
- A.
  
  Sertraline
- B.
  
  Alprazolam
- C.
  
  Amphetamine
- D.
  
  Clozapine
- E.
  
  Selegeline
2.

2) A 32-year-old man presents to his family physician with complaints about headaches. He says either a headache or a stomachache seems to interfere with his work and his boss is complaining. Upon questioning, he admits that he now finds his work is stressful but hadn’t a year ago, has lost weight over the past 6 months, sleeps all the time on the weekends, finds it hard to get up during the week, and is bored with life. His physician rules out physical ailments with several tests and suggests a diagnosis. He recommends they try pharmacotherapy that will work to increase the action of several monoamines and that they may in turn reverse stress induced damage. What is a first line drug for his condition? (Options F & G only for discussion)
- A.
  
  Clomipramine
- B.
  
  Clonazepam
- C.
  
  Chordiazepoxide
- D.
  
  Varenicline
- E.
  
  Venlafaxine
- F.
  
  Sertraline
- G.
  
  Selegiline
3.

A 19-year-old girl and her fiancé come to see her doctor to discuss her present antiepileptic drug therapy. They are to be married soon, and want to start a family. Her doctor discusses her present diagnosis of complex partial and secondarily generalized tonic-clonic seizures, from which she has suffered over the past three years. She was first treated with Drug A, which gave her severe gingival hyperplasia, acne, and mental dullness; therefore, this drug was stopped. Drug A was followed by Drug B, which caused her to gain weight, lose hair, and develop a tremor; Drug B was also was stopped. When she started on Drug X, its plasma levels seemed to decrease very quickly and the dose had to be adjusted upwards. Drug X effectively controls her condition, and the doctor says that it is safer than some of the others in pregnancy. Which of the options below correctly identifies drug X?
- A.
  
  Drug X is phenytoin
- B.
  
  Drug X is valproate
- C.
  
  Drug X is carbamazepine
- D.
  
  Drug X is ethosuximide
- E.
  
  Drug X is diazepam
4.

A 25-year-old woman presented at the emergency room with tremors, hyper-reflexia, tachycardia, mydriasis, increased bowel sounds, gait difficulties and delirium. She has a history of depression, anxiety and opiate dependence. She is currently being treated with fluoxetine, olanzepine and methadone. What best explains the symptoms she has presented with?
- A.
  
  Benzodiazepine overdose
- B.
  
  Alcohol overdose
- C.
  
  GABA syndrome
- D.
  
  Serotonin syndrome
- E.
  
  Opiate overdose
5.

A 20-year-old woman was brought to the emergency room presenting with bizarre behaviors. She was speaking very fast and she was talking about voices she heard. She had run out into the street because she thought aliens were chasing her. She was given a drug that helped block the voices and fear she was experiencing. What was the most likely identity of this drug?
- A.
  
  Clozapine
- B.
  
  Aripiprazole
- C.
  
  Asenapine
- D.
  
  Haloperidol
- E.
  
  Valproate
6.

Your 24-year-old, single, white, male, American patient presents with the following chief complaint: “I’ve been having terrible headaches for the past 6 weeks.” Upon inquiring further about the patient’s headaches and his thoughts regarding the possible cause, he responds by informing you of the following: “An evil spirit who lives in the tree in my backyard is extracting thoughts from my head and it hurts.” The type of psychiatric symptom exhibited by your patient is best described as a(n):
- A.
  
  Hallucination
- B.
  
  Delusion
- C.
  
  Illusion
- D.
  
  Parapraxis
- E.
  
  Bizarre Delusion
7.

The patient cannot remember what their boss said after he told the boss that he had lost the ongoing contract for 100 million dollars of service. This will cripple the company and cause massive layoffs at best. This memory failure is best understood as:
- A.
  
  A further symptom of CNS lesions or damage
- B.
  
  A dissociative process, often used as a defense mechanism
- C.
  
  Only caused by alcohol ingestion
- D.
  
  A predictable side effect of sleep medication
- E.
  
  A sign of a weak superego
8.

A 48-year-old woman, who had a cadaveric renal transplant 2 months ago, presented at the emergency department complaining of a fever, stiff neck, and progressively worsening headache. A lumbar puncture was performed and an elevated opening pressure was noted. CSF analysis revealed a leukocytic pleocytosis (89% PMNs) with a glucose level of 30 mg/dL (nl 40-70) and a protein level of 320 mg/dL (nl <40). All of the CSF antigen tests were negative. A Gram stain of the CSF is shown below. How was this infection most likely acquired?
- A.
  
  Inhalation of droplet nuclei
- B.
  
  Using a family member’s toothbrush
- C.
  
  Sharing contaminated needles
- D.
  
  Eating contaminated dairy products
- E.
  
  Inoculation through a cut on the skin
9.

A 29-year-old female graduate student was transported to the emergency department in coma. Her roommate reports that the woman had felt unwell for the past 48 hours while complaining of headache and fever. Salient clinical features on admission include a Glasgow Coma Scale score of 8, positive Kernig and Brudzinski signs resulting in flexion/withdrawl of the left upper extremity greater than the right upper extremity, a temperature of 102 F, and blurred optic disc margins. The rest of her vital signs were normal except for a tachycardia. What investigation should be performed first?
- A.
  
  Cold caloric testing
- B.
  
  Cranial imaging
- C.
  
  Lumbar puncture with CSF examination
- D.
  
  Cerebral angiography
- E.
  
  Skull and cervical spine x-rays
10.

A 34-year-old man was admitted to the hospital for reduction of a dislocated shoulder. Sedation with diazepam was supplemented with administration of 30% concentration of nitrous oxide. Which of the following effects most likely occurred after nitrous oxide administration?
- A.
  
  General muscle relaxation was excellent.
- B.
  
  Unconsciousness was achieved rapidly.
- C.
  
  Analgesia was very pronounced
- D.
  
  Blood pressure was sharply decreased
- E.
  
  Respiration was profoundly depressed
11.

A 45 yo male presents with an acute headache grade 3/10 and then develops sudden left hemiparesis, face and arm> leg. He speaks of mild nausea and one short episode of vomiting food from his recent meal and loses consciousness. What do you expect the diagnosis after you complete the history, PE and work up most likely to be?
- A.
  
  Migraine headache
- B.
  
  Seizure with secondary generalization
- C.
  
  Aneurysmal bleed
- D.
  
  Internal capsule stroke
- E.
  
  Intracerebral hemorrhage
12.

A 22 yo male develops a sudden onset of a generalized seizure and post-ictally has a dense left hemiplegia. He speaks of headache and on examination has hyperreflexia and a Babinski left. There is a family history of SAH. You make a differential diagnosis. How would you best manage this patient?
- A.
  
  Treat with tPA after a workup
- B.
  
  Treat with anticonvulsants after a work up
- C.
  
  Work up to r/o epilepsy
- D.
  
  Start aspirin and proceed with a workup.
- E.
  
  None of the above
13.

A 55 year old patient is seen in the ER having been found wandering around apparently lost in a shopping mall. His wife says that this problem has not happened before, although her husband has been having episodes where his memory fails. He seems well for a while then another episode happens. He never seems to recover completely and his condition is gradually worsening in almost a stepwise fashion. General neurological exam is normal. The most likely diagnosis is:
- A.
  
  Vascular dementia
- B.
  
  Frontotemporal dementia
- C.
  
  Alcoholism
- D.
  
  Alzheimer’s
- E.
  
  PCA (posterior cerebral artery) stroke
14.

Joan is 45 years old. She is brought to Emergency having passed out in the street. She was witnessed having jerky movements and was incontinent. It is now 45 minutes since this happened and Joan has had another two episodes on the way to hospital and yet another as she arrives. Her best pharmacological management would MOST LIKELY BE INITIATED by:
- A.
  
  Oxygen and gentle restraint
- B.
  
  IV thiamine diazepam
- C.
  
  Observation only
- D.
  
  Oral diazepam
- E.
  
  Valproic acid IM
- F.
  
  Oral ethosuximide
15.

A 62-year-old male presents with headache, vomiting and weakness of his left side. Physical examination reveals his right eye to be pointing “down and out” and ptosis of his right eyelid. His right pupil is fixed and dilated unresponsive to accommodation. There is also marked weakness in his left arm and leg. There is papilledema on examination of the retina. These manifestations are most likely associated with which of the following?
- A.
  
  Aneurysm of the vertebrobasilar artery
- B.
  
  Arteriovenous malformation of the anterior cerebral artery
- C.
  
  Subfalcine herniation
- D.
  
  Tonsillar herniation
- E.
  
  Uncal herniation
16.

A 28-year-old woman began to stumble when walking. Her right leg was slightly stiff and weak, especially after exercise and hot showers. These symptoms developed over 3 days and gradually disappeared over 4 weeks. One year later, 10 days after a “cold,” she developed blurred vision in her right eye and her visual acuity dropped to 20/200. She had moderate pain behind her eye when she looked to either side. Two years later, she noticed that both legs were becoming gradually weaker and spastic and she needed to run to the bathroom nearly every hour to urinate. These symptoms slowly progressed over the next 10 years, with occasional exacerbations affecting other areas of the brain. Which of the following brain structures are the most common sites for formation of lesions in this patient?
- A.
  
  Paraventricular white matter, optic nerve, brainstem, and grey matter of the spinal cord
- B.
  
  Paraventricular grey matter, brainstem, and grey matter of the spinal cord
- C.
  
  Cerebral white matter, optic nerve- chiasm, brainstem, and white matter of the spinal cord
- D.
  
  Basal ganglia, optic nerve, brain stem, and white matter of the spinal cord
17.

A 72-year-old woman presented for evaluation of "short-term memory loss" at the behest of her family. The patient acknowledged memory difficulty but no more than her age-peers. History was, therefore, obtained from her daughter. Difficulties in cognition and daily function were first noted about 3 years earlier, shortly after she was widowed. More recently, she had discontinued her regular church attendance, had been noted to wear dirty clothing. On cognitive examination, she was not oriented to date or month, but could identify the day of the week. She could repeat 3 words, but recalled none after 5 minutes of distraction. She correctly named the president, but not the governor. She could not recount any recent major news events. She could name a watch, pencil, and jacket, but could not name the lapel, sleeve, or cuff. She correctly drew a clock, but could not set the hands to 8:20. General neurologic examination was unrevealing, apart from diminished large fiber sensation in the distal lower extremities, and a mildly unsteady gait. Which of the following pathologic changes are characteristic for her disease?
- A.
  
  Cortical atrophy, neurofibrillary tangles, and neuritic plaques
- B.
  
  Lewy bodies, neurofibrillary tangles, and neuritic plaques
- C.
  
  Neurofibrillary tangles, neuritic plaques, and watershed liquefactive necrosis
- D.
  
  Amyloid angiopathy, loss of neurons in the caudate and hippocampus, and senile plaques
18.

A 43-year-old white male complains to his family physician of increasingly severe headaches upon awakening of a few months' duration; the headaches persist throughout the afternoon and are mild in the evenings. While in the doctor's office, the patient suffers a seizure and is brought to the emergency room. Fundoscopy reveals papilledema. A CT scan ordered has a large frontal lobe mass with focal nodular calcifications. Which of the following criteria are used for the surgical pathology diagnosis of the lesion present in this patient?
- A.
  
  Pleomorphic glial cells, high mitotic activity, pseudopalisading, + vascular proliferation
- B.
  
  Cyst with mural nodule, pilocytic astrocytes with Rosenthal fibers
- C.
  
  Well circumscribed nodule, whorls of spindle-shaped cells, and psammoma bodies
- D.
  
  Bipolar elongated cells, long fibrils “hairy cells” and Rosenthal fibers
- E.
  
  Well circumscribed nodule, “fried-egg” cells, and chicken-wire capillary pattern
19.

A 56-year-old diabetic female was in her usual state of health until 6 weeks prior to admission, when she had a 3-week episode of apparent “flu” characterized by fatigue, aching joints, nausea, vomiting, and headache. She recovered briefly, but then had recurrence of headaches. Two weeks prior to admission the patient became confused and was hospitalized. On admission she was found to be febrile to 104.6°F and significantly dehydrated. Hematocrit was normal. White blood count was 15,000, with 94% polymorphonuclear leukocytes. Blood sugar was 230 mg/dl, but ketones were absent. Head MRI showed in excess of 10 ring-enhancing and solid lesions scattered throughout both cerebral hemispheres, with surrounding edema. Production of connective tissue and collagen accumulation in this patient are characteristically associated with one of the following:
- A.
  
  Chronic brain abscess
- B.
  
  Creutzfeldt-Jacob disease
- C.
  
  Multiple sclerosis
- D.
  
  Alzheimer disease
- E.
  
  Amyotrophic Lateral Sclerosis
20.

A 58-year-old female was admitted because had been disoriented with respect to time, she was also noted to be severely depressed, with crying spells. Her speech was slow and dysarthric with an irregular rhythm and explosive quality. Repetition, naming, and comprehension were impaired. She could read words, but apparently without understanding, and she was unable to write. She showed apraxia for motor and eye movements and demonstrated perseveration, right-left confusion, and difficulty with calculations. Her fund of knowledge was markedly reduced. Cranial nerve abnormalities were limited to a decrease in the range of upward gaze and a flattening of the left nasolabial field. The limbs were bilaterally spastic with generally hyperactive tendon reflexes, especially on the left. A jaw jerk was prominent and the left plantar response was extensor. The right hand was maintained in a position of dystonic hyperextension with trapping of the thumb. There was an ataxic tremor in the arms and legs. Gait was wide based and unsteady. Occasional irregular jerking of the right arm and leg was present at rest and increased during attempts at voluntary movement. During the next 2 weeks, she deteriorated rapidly, becoming incontinent with progressively increasing spasticity and more frequent jerks. Speech continued to worsen until it ceased altogether. The neuropathologic findings were typical of Creutzfeldt-Jakob disease. A diagnosis of possible familial Creutzfeldt-Jakob disease was raised although no genetic testing was available for further investigations. Which of the following biochemical processes underlies the demonstrated pathology?
- A.
  
  Accumulation of paired helical filaments in the neurophil
- B.
  
  Extracellular accumulation of Aβ-amyloid
- C.
  
  Accumulation of β-pleated prion proteins in the neurophil
- D.
  
  Intracellular accumulation of α-helical prion proteins
- E.
  
  Intracellular accumulation of a protein with polyglutamine repeat expansion
21.

A 32-year-old white female, who migrated to the US form Finland 10 years ago, presents with loss of vision in her left eye with eye pain and impairment of color vision; the symptoms started two weeks prior to attending to the clinic and then gradually progressed. Fundoscopy reveals a swollen optic disk in the left eye. Which of the following are the most likely concomitant brain changes that can be identified by MRI?
- A.
  
  Foci of demyelination in the paraventricular white matter
- B.
  
  Tumor affecting the white matter of both cerebral hemispheres
- C.
  
  Accumulation of thick exudate at the base of the brain
- D.
  
  Diffuse rarefaction of the subcortical white matter
- E.
  
  Hemorrhages in the right temporal lobes
22.

A 46-year-old male AIDS patient died of pontine infarct. Microscopic report of the autopsy study was arteritis of the basilar artery along with abundant monomorphic, septate, filamentous organisms with dichotomous branching enhanced with silver methenamine stain. What is the most likely diagnosis?
- A.
  
  Candidiasis
- B.
  
  Mucormycosis
- C.
  
  Blastomycosis
- D.
  
  Aspergillosis
- E.
  
  Actinomycosis
23.

A 24-year-old woman who wants to become pregnant has had no menses since she discontinued the use of an oral contraceptive one year ago, and recently, galactorrhea developed. She takes no medications and has had no headaches, visual loss, dyspareunia, or decreased libido. Physical examination shows no abnormalities except for bilateral breast discharge. A test of serum human chorionic gonadotropin is negative, and the serum LH and estradiol levels are below normal. Which one of the following is the most likely cause of these signs and symptoms?
- A.
  
  Prolactinoma of the pituitary gland
- B.
  
  Germinoma of the pineal gland.
- C.
  
  Medullary carcinoma of the thyroid gland
- D.
  
  Craniopharyngioma of the hypotalamus
- E.
  
  Islet cell adenoma of the pancreas