Block 13 Pace 1 Prt 3
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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
Correct Answer
B. Major depressive disorderExplanation
Based on the patient's symptoms of dysphoric mood, difficulty concentrating, sleep disturbance, appetite disturbance, back pain, headache, and fatigue, the most likely type of mood disorder exhibited by this patient is Major depressive disorder. These symptoms are consistent with the diagnostic criteria for major depressive disorder, which includes the presence of several depressive symptoms for at least two weeks.Rate this question:
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- 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
Correct Answer
C. SchizopHrenia, Disorganized TypeExplanation
The patient's response to the proverb is nonsensical and shows disorganized thinking, which is a characteristic symptom of schizophrenia, disorganized type. Additionally, the patient's unkempt appearance, wearing multiple layers of clothing on a hot day, and flat affect with low amplitude and constricted range are consistent with the disorganized type of schizophrenia.Rate this question:
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- 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
Correct Answer
E. Acute Stress DisorderExplanation
Based on the reported symptoms, the best DSM IV classification at this time is Acute Stress Disorder. The patient is experiencing intense fear and avoidance of certain situations (going in the basement, using the elevator) after a recent strong earthquake, which is a traumatic event. She also describes feeling emotionally numb and detached from herself, as well as physical symptoms like excessive sweating and heightened perception of lights. These symptoms are consistent with the criteria for Acute Stress Disorder, which is characterized by the development of dissociative and anxiety symptoms following exposure to a traumatic event.Rate this question:
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- 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
Correct Answer
E. Somatoform disorderExplanation
Based on the patient's long list of bodily complaints, including headaches, stomach aches, limb pains, gas, weakness in the hands, insomnia, and lack of interest in sexual activity, it is likely that the previous doctor diagnosed the patient with a somatoform disorder. Somatoform disorders are characterized by physical symptoms that cannot be fully explained by a medical condition and are often associated with psychological distress. In this case, the patient's symptoms have persisted for three years, suggesting a chronic nature, which is consistent with a somatoform disorder.Rate this question:
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- 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
Correct Answer
A. Embolism of the left middle cerebral arteryExplanation
The most likely cause of the shown brain changes is embolism of the left middle cerebral artery. This is because the changes are consistent with a sudden occlusion of a blood vessel, which is commonly caused by an embolus blocking the artery. Thrombosis of the artery would result in a more gradual occlusion and may not cause such sudden changes. Rupture of a berry aneurysm or Charcot-Bouchard aneurysm would result in hemorrhage, not occlusion. Arteriovenous malformation would also cause hemorrhage rather than occlusion.Rate this question:
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- 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
Correct Answer
D. Temporal, frontal and parietal cortex, and hippocampusExplanation
The patient in the scenario is experiencing memory problems and difficulty with daily tasks, such as remembering where books go and turning off the stove. These symptoms are indicative of cognitive decline, which is commonly associated with Alzheimer's disease. The temporal, frontal, and parietal cortex, as well as the hippocampus, are the brain structures primarily affected in Alzheimer's disease. These areas of the brain are crucial for memory formation, learning, and cognitive functions. Therefore, the correct answer is temporal, frontal and parietal cortex, and hippocampus.Rate this question:
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- 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
Correct Answer
B. Pilocytic astrocytomaExplanation
The most likely diagnosis in this case is pilocytic astrocytoma. This is supported by the presence of severe headache, nausea, and vomiting, as well as physical examination findings of bilateral papilledema and unsteadiness of gait and posture. Pilocytic astrocytoma is a slow-growing, low-grade tumor that commonly occurs in children and is often located in the cerebellum. The brain MRI and stereotactic brain biopsy would provide further evidence for this diagnosis. Fibrillary astrocytoma, glioblastoma multiforme, medulloblastoma, and ependymoma are less likely based on the clinical presentation and imaging findings.Rate this question:
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- 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
Correct Answer
B. LamotrigineExplanation
A) Phenytoin is Drug X B) Valproate is Drug Y C) Carbamazepine is Drug Z D) Felbamate is a 2nd or 3rd line drug for patients who appear to be resistant to other drugs and is a broad spectrum 2nd generation drug antiepileptic E) *Lamotrigine is a second generation broad spectrum drug that can be used as a drug with low risk effects of teratogenic effects vs health benefits for the mother.Rate this question:
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- 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
Correct Answer
D. L-DOPAExplanation
A) *the decarboxylase inhibitor blocks the breakdown of L-DOPA to dopamine so one avoids peripheral side effects
B) An enzyme which breaks down dopamine
C) neurotransmitter or part of ATP or cAMP
D) this is the decarboxylase inhibitor
E) This is not the compound we want to increase in the peripheryRate this question:
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- 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)
Correct Answer
D. DiazepamExplanation
The patient likely requested Diazepam because it is a drug that can help with insomnia, muscle relaxation, and anxiety symptoms. This aligns with the patient's complaints of waking up and worrying about everything, feeling stressed all the time, and having a history of headaches and GI distress. Diazepam is a benzodiazepine that can effectively treat these symptoms and promote sleep.Rate this question:
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- 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
Correct Answer
C. MethadoneExplanation
Methadone would be contraindicated in this patient because it can prolong the QT interval, which is already a concern due to the patient's history of long QT syndrome. The other opioids listed do not have this specific contraindication.Rate this question:
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- 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
Correct Answer
D. MethylprednisoloneExplanation
The correct answer is Methylprednisolone. Methylprednisolone is a corticosteroid that is commonly used in the treatment of multiple sclerosis (MS). It helps to reduce inflammation and suppress the immune system, which can help relieve symptoms of MS. The fact that the drug is delivered as a daily IV bolus dose over a period of 5 days suggests that it is a short-term treatment aimed at providing immediate relief of symptoms. Interferon beta 1a, Natalizumab, Riluzole, and Fingolimod are also used in the treatment of MS but they are not typically administered as a daily IV bolus dose.Rate this question:
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- 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
Correct Answer
A. Herpes simplex virusExplanation
The most likely causative agent in this case is Herpes simplex virus. This is suggested by the acute onset of fever, right-sided headache, personality changes, and the presence of swelling in the right temporal lobe on CT scan. Additionally, the CSF analysis reveals lymphocytic pleocytosis (elevated lymphocytes), which is commonly seen in viral infections such as herpes simplex virus. The absence of organisms on gram stain and negative bacterial culture further supports a viral etiology. Other options such as Streptococcus pneumoniae, Neisseria meningitidis, West Nile virus, and Cryptococcus neoformans are less likely based on the clinical presentation and CSF findings.Rate this question:
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- 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
Correct Answer
C. Catalase-positive, oxidase-positive, Gram-negative cocci in pairsExplanation
The key morphologic features of the most likely causative agent in this scenario are catalase-positive, oxidase-positive, Gram-negative cocci in pairs. This is suggested by the clinical presentation of fever, headache, neck stiffness, and photophobia, along with the presence of a petechial rash and abnormal CSF findings. These features are consistent with meningococcal meningitis, which is caused by the bacteria Neisseria meningitidis. Neisseria meningitidis is a Gram-negative diplococcus that is catalase-positive and oxidase-positive, and it commonly presents as pairs of cocci on microscopic examination.Rate this question:
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- 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
Correct Answer
A. Migraine headacheExplanation
Based on the given information, the most likely first differential diagnosis before starting the physical examination would be a migraine headache. The patient's symptoms of a mild hemiparesis followed by a throbbing headache that is aggravated by coughing and straining are characteristic of a migraine. Migraines can cause temporary weakness or paralysis on one side of the body (hemiparesis) known as a migraine aura. The headache associated with migraines is often throbbing in nature and can be worsened by physical activity. Nausea is also a common symptom of migraines. Therefore, considering all these symptoms, a migraine headache is the most likely first differential diagnosis.Rate this question:
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- 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
Correct Answer
B. TPA workup and then treat accordinglyExplanation
The correct answer is tPA workup and then treat accordingly. Given the sudden onset of seizure, dense left hemiplegia, headache, hyperreflexia, and Babinski sign, along with a family history of subarachnoid hemorrhage (SAH), the most likely cause is an acute ischemic stroke. Therefore, the initial step would be to perform a workup including imaging studies such as CT or MRI to confirm the diagnosis and determine the eligibility for thrombolytic therapy with tPA. Once the workup is completed and the patient is deemed eligible, appropriate treatment can be initiated.Rate this question:
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- 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
Correct Answer
A. StrokeExplanation
The sudden onset of a generalized seizure, followed by a dense left hemiplegia and persistent hyperreflexia with a Babinski sign on day two, suggests a vascular etiology. The presence of a family history of SAH further supports this. Aneurysmal SAH is the most likely top differential diagnosis in this case, as it can cause sudden neurological deficits and seizures. While stroke can also cause similar symptoms, the history of SAH in the family makes aneurysmal SAH a more likely possibility.Rate this question:
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.JPG "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?")
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Mar 18, 2023Quiz Edited by
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Sep 22, 2012Quiz Created by
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