Clinical Medicine Exam III

45 Questions | By Matthewlfowler | Updated: Mar 21, 2022 | Attempts: 554

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The following Practice Exam is for Block 3 Clinical Medicine - Exam III. There are 45 questions on this exam and you will have 55 minutes to complete the exam. Feedback will be provided at the end of the exam.

Questions and Answers

1.

Humans spend the longest portion of sleep in which stage that is also characteristic of spindles and K-complexes?
- A.
  
  Stage 1
- B.
  
  Stage 2
- C.
  
  Stage 3
- D.
  
  Stage 4
- E.
  
  REM sleep
2.

Sleep spindles are primarily a result of which of the following locations and neurotransmitter activity?
- A.
  
  Glutamine on the lateral reticular nucleus.
- B.
  
  Gamma-amino butyric acid on the lateral reticular nucleus.
- C.
  
  Norepinephrine on the lateral reticular nucleus.
- D.
  
  Gamma-amino butyric acid on the locus coeruleus.
- E.
  
  Histamine on the locus coeruleus.
3.

Histamine promotes wakefulness via transmission to the entire central nervous system. Histamine is produced in the…
- A.
  
  Lateral reticular nucleus
- B.
  
  Locus coeruleus
- C.
  
  Tubomammary nucleus
- D.
  
  Substantia nigra
- E.
  
  Superchiasmatic nucleus
4.

Circadian rhythm can be attributed to the regulation of melatonin secretion from the pineal gland. Which of the following hypothalamic nuclei is responsible for this regulation?
- A.
  
  Lateral reticular nucleus
- B.
  
  Locus coeruleus
- C.
  
  Tubomammary nucleus
- D.
  
  Substantia nigra
- E.
  
  Superchiasmatic nucleus
5.

Abnormally low or absent levels of hypocretin are commonly associated with which of the following sleep disorders?
- A.
  
  Obstructive sleep apnea
- B.
  
  Narcolepsy
- C.
  
  Exploding head syndrome
- D.
  
  Sleep eating related disorder
- E.
  
  REM sleep behavior disorder
6.

A 35 year-old male visits his neurologist for a follow-up. Two months ago the patient had a berry aneurysm rupture and has been recovering from symptoms that developed following the event. He discusses with his physician that he is continuing to have problems at home reaching for and grasping items such as his coffee mug with his right hand, but does not have problems with this action using his left hand. Which of the following disorders does this patient have?
- A.
  
  Physiologic tremor
- B.
  
  Cerebellar tremor
- C.
  
  Rest tremor
- D.
  
  Focal tremor
- E.
  
  Focal dystonia
7.

A 45 year-old female presents with a bilateral focal dystonia of the orbicularis oculi. The physician treats the problem with an injection of Botulinum toxin. Which of the following disorders does this patient have?
- A.
  
  Torticollis
- B.
  
  Oromandibular dystonia
- C.
  
  Spasmotic dysphonia
- D.
  
  Blepharospasm
- E.
  
  Ataxic dystonia
8.

Which of the following disorders manifests with both choreoform and dystonic symptoms?
- A.
  
  Tardive dyskinesia
- B.
  
  Huntington's disease
- C.
  
  Parkinson's disease
- D.
  
  Myoclonus
- E.
  
  Wilson's disease
9.

Which of the following is NOT a clinically diagnostic feature of Huntington’s chorea?
- A.
  
  Bradykinesia
- B.
  
  Onset before the age of 20
- C.
  
  Progressive neurological psychosis
- D.
  
  Progressive destruction of the substantia nigra
- E.
  
  Progressive destruction of the caudate nucleus
10.

Which of the following is NOT one of the four cardinal features of Parkinson’s disease?
- A.
  
  Bradykinesia
- B.
  
  Tremor
- C.
  
  Psychosis
- D.
  
  Postural instability
- E.
  
  Muscular rigidity
11.

A 15-year-old high school student suffered from a sudden onset of altered consciousness while chatting with his classmate. He was sent to the emergency room where neurologic examinations revealed drowsiness with slurred speech and clonic-jerky movements of his 4 limbs. No nausea or vomiting was noted. No significant social or family history. No systemic diseases, such as hypertension, diabetic mellitus or other coagulopathy. Laboratory values were within normal limits. CT revealed no hemorrhage, infarction or tumor. He regained consciousness one hour later, but with bilateral total ophthalmoplegia, no verbal output and total quadriplegia. Which of the following is consistent with his background, symptoms, and diagnostic details?
- A.
  
  Internal carotid occlusion
- B.
  
  Lacunar stroke syndrome
- C.
  
  Posterior cerebral artery syndrome
- D.
  
  Vertebrobasilar artery syndrome
- E.
  
  Anterior cerebral artery syndrome
12.

A 29 year-old female presented to the emergency room in significant pain to the left side of her head. She describes the pain as “the worst headache of her life”. She stated that she just returned from a run and was preparing to take her blood pressure medicine for the day when the attack suddenly occurred. She has no previous history of migraines, but has been taking medicine for hypertension. Her blood pressure upon arriving at the emergency room was 182/98. Her left pupil was dilated. She exhibited neither loss of consciousness nor loss of cognition or confusion; she states that she has not injured herself recently and she is alert. Which of the following is the most likely diagnosis given her symptoms and history?
- A.
  
  Acute head injury
- B.
  
  Acute ischemic stroke
- C.
  
  Ruptured intracerebral aneurysm
- D.
  
  Hypertensive intracerebral hemorrhage
- E.
  
  Epidural hemorrhage
13.

A 65 year-old male presents to the emergency room. He states that 5 hours ago he had the onset of slurred speech and left arm weakness that improved after 2 hours. His then called his daughter who brought him to the emergency room. The patient seems healthy and has no sequelae from the recent event. Which of the following additional pieces of information would NOT support that this patient experienced a recent transient ischemic attack?
- A.
  
  The patient has significant high blood pressure on which remains high while he is at the emergency room.
- B.
  
  The patient has a normal MRI upon immediately arriving at the emergency room.
- C.
  
  The patient has a normal CT upon immediately arriving at the emergency room.
- D.
  
  The patient has an abnormal MRI seven days later.
- E.
  
  The patient has an abnormal CT 12 hours later.
14.

Mr. Smith is a 85 year old male presenting to the emergency room with a mild headache. His daughter brought him in because he described some numbness on the right side of his face. He does have a history of hypertension and hypercholesterolemia. He was a 1ppd smoker for nearly 45 years, but quit 13 years prior. Which of the following imaging modalities would be best utilized to accurately and rapidly detect a possible ischemic stroke that may have occurred?
- A.
  
  MRA
- B.
  
  CTA
- C.
  
  CT with contrast
- D.
  
  Diffusion-weighted MRI
- E.
  
  Transesophageal echocardiogram
15.

Which of the following would contraindicate the use of recombinant-tissue plasminogen activator in a stroke patient?
- A.
  
  Normal, negative contrast CT
- B.
  
  Systolic blood pressure of 160
- C.
  
  Diastolic blood pressure of 92
- D.
  
  Presentation 5 hours post symptom onset
- E.
  
  Head surgery 6 months ago
16.

Which of the following bacterial organisms is responsible for the majority of bacterial meningitis cases in the United States of America?
- A.
  
  Streptococcus agalactae
- B.
  
  Neisseria meningitidis
- C.
  
  Streptococcus pneumoniae
- D.
  
  Haemophilus influenzae
- E.
  
  Listeria monocytogenes
17.

The most common route of infection for bacterial meningitis is…
- A.
  
  Head trauma
- B.
  
  Direct extension via otitis media
- C.
  
  Direct extension via sinusitis
- D.
  
  Genetic cribiform plate malformation
- E.
  
  Hematogenous
18.

Which of the following organisms is most responsible for bacterial meningitis in newborns?
- A.
  
  Streptococcus agalactae
- B.
  
  Neisseria meningitidis
- C.
  
  Streptococcus pneumoniae
- D.
  
  Haemophilus influenzae
- E.
  
  Listeria monocytogenes
19.

A 32 year-old male was brought into the emergency room with seizures and cognitive loss. The patient smelled of alcohol and numerous skin lesions were present on his arms. Radiological imaging was negative for mass lesions and a lumbar puncture was obtained which indicated numerous neutrophils, increased protein, and hypoglycorrhachia. He was subsequently treated with vancomycin and oxacillin following culture sensitivity. Which of the following is the likely offending organism?
- A.
  
  Coagulase positive Staphylococcus aureus
- B.
  
  Coagulase negative Staphylococcus aureus
- C.
  
  Pseudomonas aeruginosa
- D.
  
  Neisseria meningitidis
- E.
  
  Streptococcus pneumoniae
20.

Which of the following drugs or drug combinations is considered the empirical treatment for suspected cases of bacterial meningitis until cultures are obtained?
- A.
  
  3rd generation cephalosporin, vancomycin
- B.
  
  3rd generation cephalosporin, gentamicin
- C.
  
  Ampicillin, 3rd generation cephalosporin
- D.
  
  Ampicillin, 3rd generation cephalosporin, vancomycin
- E.
  
  Ampicillin, 3rd generation cephalosporin, gentamicin
21.

What percent of brain abscesses can be attributed to nasopharyngeal infections?
- A.
  
  30%
- B.
  
  40%
- C.
  
  50%
- D.
  
  60%
- E.
  
  70%
22.

Which of the following drugs or drug combinations is considered the empirical treatment for a brain abscess until cultures are obtained?
- A.
  
  3rd generation cephalosporin, metronidazole
- B.
  
  Ampicillin, 3rd generation cephalosporin, metronidazole
- C.
  
  Penicillin G, 3rd generation cephalosporin, metronidazole
- D.
  
  Ampicillin, 3rd generation cephalosporin, vancomycin
- E.
  
  Penicillin G, 3rd generation cephalosporin, vancomycin
23.

Which of the following is NOT a diagnostic indication in cerebrospinal fluid of encephalitis due to parasitic infection?
- A.
  
  Elevated white blood cell count
- B.
  
  Elevated eosinophils
- C.
  
  Normal lymphocytes
- D.
  
  Hypoglycorrhachia
- E.
  
  Normal protein
24.

Which of the following is a contraindication to performing a lumbar puncture in order to obtain cerebrospinal fluid?
- A.
  
  Calcified brain lesion on a CT
- B.
  
  Displaced lateral ventricles
- C.
  
  Radiological evidence of severe cerebral edema
- D.
  
  Petechial rash
- E.
  
  Enhancing lesion on an MRI
25.

Which of the following is NOT one of the four most common presenting symptoms of meningitis?
- A.
  
  Headache
- B.
  
  Seizures
- C.
  
  Fever
- D.
  
  Meningismus
- E.
  
  Altered sensorium