Block 13 Pace 1 Prt 3

17 Questions | Total Attempts: 211

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Block 13 Pace 1 Prt 3 - Quiz

Questions and Answers
  • 1. 
    A 42-year-old female patient presents with a history of type II diabetes. She complains of dysphoric mood, difficulty concentrating, sleep disturbance, appetite disturbance, back pain, headache and fatigue for the past three weeks.  What is the most likely type of mood disorder exhibited by this patient?
    • A. 

      Cyclothymic disorder

    • B. 

      Major depressive disorder

    • C. 

      Dysthymic disorder

    • D. 

      Melancholia

    • E. 

      Mood disorder due to a general medical condition

  • 2. 
    In the context of a mental status exam, a 32-year-old patient is asked to interpret the proverb, “The tongue is the enemy of the neck.” His response is as follows: “Well, the intraocular parastangies is inverted like to the left but it could be extrapolated linearly with declining output depending on the circumference and rate of exchange.” General appearance reveals an unkempt, disheveled man wearing several layers of clothing on a stifling hot summer day. Affect was flat, marked by low amplitude and constricted range. What is the most likely psychiatric diagnosis in this case?
    • A. 

      Schizophrenia, Paranoid Type

    • B. 

      Schizophrenia, Catatonic Type

    • C. 

      Schizophrenia, Disorganized Type

    • D. 

      Schizophrenia, Undifferentiated Type

    • E. 

      Schizophrenia, Residual Type

  • 3. 
    The patient is a 37 year old woman with three young children. She describes having intense fear of going in the basement of her house after a recent strong earthquake. She is also now afraid when using the elevator to get to her work office on the 21st floor. She feels emotionally numb and sometimes like she is just watching herself go through the day; she perspires heavily and says the lights seem to be getting brighter This has been going on for the last two weeks, and does not seem to be getting better or worse during that time. Based on the reported symptoms, which is the best DSM IV classification at this time?
    • A. 

      Generalized Anxiety Disorder

    • B. 

      Specific Phobia

    • C. 

      Agoraphobia

    • D. 

      Social phobia

    • E. 

      Acute Stress Disorder

  • 4. 
    The patient is a 29 year old man who has a long list of bodily complaints, from headaches, to stomach aches to limb pains to gas, to weakness in the hands. He also has insomnia and reports a complete lack of interest in sexual activity. He has had these symptoms off and on for the last three years is asking you for a second opinion. What diagnosis do you suspect the previous doctor used?
    • A. 

      Hypochondriasis

    • B. 

      Conversion disorder

    • C. 

      Body Dysmorphia

    • D. 

      Anxiety disorder

    • E. 

      Somatoform disorder

  • 5. 
    Postmortem examination of a 53-year-old African American woman, who died suddenly, reveals the brain changes shown for your evaluation below. Which of the following is the most likely cause of the shown changes?
    • A. 

      Embolism of the left middle cerebral artery

    • B. 

      Thrombosis of the left middle cerebral artery

    • C. 

      Rupture of a berry aneurysm

    • D. 

      Rupture of a Charcot-Bouchard aneurysm

    • E. 

      Arteriovenous malformation

  • 6. 
    A 69-year-old well-educated woman is brought to the physician by her daughter, who has become concerned about her mother’s behavior. The mother volunteers at the local library shelving books, but for the past few months she has had trouble remembering where the books go.  In addition, she often forgets to turn off the stove after cooking her family’s long-time favorite dishes. Which of the following brain structures are most likely affected by the disease process in this patient?
    • A. 

      Brainstem, amygdala, substantia nigra, thalamus, and cerebral cortex

    • B. 

      Frontal and temporal lobes, caudate nucleus, and putamen

    • C. 

      Caudate nucleus, putamen, globus pallidus, and frontal cortex

    • D. 

      Temporal, frontal and parietal cortex, and hippocampus

    • E. 

      Periventricular grey matter, medial thalamus, cerebellar vermis, and cortex

  • 7. 
    A 5-year-old girl is brought to the pediatrician with severe headache, nausea, and vomiting. Physical examination reveals bilateral papilledema and unsteadiness of gait and posture. Further investigation includes brain MRI and stereotactic brain biopsy shown for your evaluation in the images given below. Which of the following is the most likely diagnosis?
    • A. 

      Fibrillary astrocytoma

    • B. 

      Pilocytic astrocytoma

    • C. 

      Glioblastoma multiforme

    • D. 

      Medulloblastoma

    • E. 

      Ependymoma

  • 8. 
    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 X which gave her severe gingival hyperplasia, acne, and mental dullness, therefore this drug was stopped. Drug X was followed by Drug Y which caused her to gain weight, lose hair, and develop a tremor; Drug Y was also was stopped. When she started on Drug Z, its plasma levels seemed to decrease very quickly and the dose had to be adjusted upwards.  Drug Z effectively controls her condition, but is still a first generation antiepileptic.  Which of the options below correctly identifies a second generation drug that could be considered to see if it controls her seizures prior to getting pregnant?
    • A. 

      Phenytoin

    • B. 

      Lamotrigine

    • C. 

      Carbamazepine

    • D. 

      Felbamate

    • E. 

      Valproate

  • 9. 
    A 75-year-old man presents with resting tremors, slow shuffling gait and masked facial expressions.  His physician decides to start him on replacement therapy for his condition, drug X.  Drug X is always given with a decarboxylase inhibitor to increase the peripheral plasma half-life or duration of what neurochemical?
    • A. 

      Carbidopa

    • B. 

      Monoamine oxidase

    • C. 

      Adenosine

    • D. 

      L-DOPA

    • E. 

      Dopamine

  • 10. 
    A 38-year-old woman presents to a new physician with complaints of insomnia.  Her previous doctor will no longer give her a prescription for insomnia.  She says she wakes up and worries about everything and cannot go to sleep. She has a history of headaches and GI distress. She states she feels stressed all the time for as long as she can remember. She requests a specific drug. This drug is known to shorten time to sleep but also is a muscle relaxant and can block anxiety symptoms. What drug did she likely request?
    • A. 

      Zaleplon

    • B. 

      Sertraline

    • C. 

      Baclofen

    • D. 

      Diazepam

    • E. 

      Codeine

    • F. 

      Eszopiclone (for discussion only)

  • 11. 
    A 75-year-old man is diagnosed with advanced cancer.  He has history of long QT syndrome which is controlled by appropriate medication.  As part of his cancer treatment regime he is prescribed an opioid analgesic for pain relief.  Which of the following drugs would be contraindicated in this patient?
    • A. 

      Codeine

    • B. 

      Buprenorphine

    • C. 

      Methadone

    • D. 

      Tramadol

    • E. 

      Fentanyl

  • 12. 
    A 42-year-old woman is diagnosed with multiple sclerosis.  As part of her treatment regimen, she receives a drug delivered as a daily IV bolus dose over a period of 5 days which relieves her current symptoms.  What is the drug most likely administered to this patient?
    • A. 

      Interferon beta 1a

    • B. 

      Natalizumab

    • C. 

      Riluzole

    • D. 

      Methylprednisolone

    • E. 

      Fingolimod

  • 13. 
    A 50-year-old previously healthy woman is evaluated in January for the acute onset of fever, right-sided headache, and personality changes.  She also complains that the lighting in the exam room is “too bright”.  On physical examination, the patient is disoriented and febrile with a temperature of 38.3°C (101.0°F). Her neck is supple and there are no focal neurologic deficits.  A CT scan of the head reveals swelling of the right temporal lobe.  A lumbar puncture is performed and CSF analysis reveals the following:               Lab test                                   Result                                   Reference Range Total WBC count                     50 cells/mm3                        0-5             Differential cell count              100% lymphocytes                                          Glucose                                   60 mg/dL                              40-70             Protein                                     120 mg/dL                            <40             Gram stain                               No organisms seen                                           Bacterial C&S                          No growth   What is the most likely causative agent?
    • A. 

      Herpes simplex virus

    • B. 

      Streptococcus pneumoniae

    • C. 

      West Nile virus

    • D. 

      Neisseria meningitidis

    • E. 

      Cryptococcus neoformans

  • 14. 
    A 20-year-old female college freshman is evaluated in the emergency department for a 1-day history of headache, fever, and neck stiffness.  On physical examination, the patient appears ill and has photophobia. Vital signs include temperature of 39.3°C (102.7°F) and a blood pressure of 80/56 mm Hg.  A petechial rash most prominent on the lower extremities and trunk is noted.  Passive neck flexion causes discomfort.  A lumbar puncture is performed and CSF analysis reveals a neutrophilic pleocytosis, low glucose concentration, and an elevated protein level.   What are the key morphologic features of the most likely causative agent?
    • A. 

      Catalase-negative, optochin-sensitive, Gram-positive cocci in pairs

    • B. 

      Catalase-negative, beta-hemolytic, Gram-positive cocci in pairs and short chains

    • C. 

      Catalase-positive, oxidase-positive, Gram-negative cocci in pairs

    • D. 

      Catalase-positive, coagulase-positive, Gram-positive cocci in clusters

    • E. 

      Catalase-positive, beta-hemolytic, motile, Gram-positive rods

  • 15. 
    A 45-year-old male presents with an onset of a mild hemiparesis which begins in his left hand, moves up to involve his arm and then slowly resolves after 20 minutes. This is followed by a grade 5/10 throbbing headache which is aggravated by coughing and straining and associated with nausea. What do you expect the most likely first differential diagnosis to be before you start your physical examination?
    • A. 

      Migraine headache

    • B. 

      Focal Jacksonian seizure

    • C. 

      TIA

    • D. 

      Aneurysmal bleed

    • E. 

      Intracerebral hemorrhage

  • 16. 
    A 22-year-old 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. How would you go about evaluating him?
    • A. 

      Treat with anticonvulsants after a work up

    • B. 

      TPA workup and then treat accordingly

    • C. 

      Work up to r/o epilepsy

    • D. 

      Start Asprin and proceed with a workup

    • E. 

      None of the above

  • 17. 
    A 22-year-old 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 which is unchanged on day two. There is a family history of SAH. What is most likely the top differential?
    • A. 

      Stroke

    • B. 

      Generalized seizure

    • C. 

      Focal seizure with secondary generalization

    • D. 

      Aneurysmal SAH

    • E. 

      Complicated migraine

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