32-year-old presents with new-onset HA characterized by unilateral, stabbing eye pain. During these episodes the pt develops runny nose and conjunctival injection on the same side was the headache. These episodes occur every evening after falling asleep and last up to two hours. Based on the hx, th...
32-year-old presents with new-onset HA characterized by unilateral, stabbing eye pain. During these
episodes the pt develops runny nose and conjunctival injection on the same side was the headache.
These episodes occur every evening after falling asleep and last up to two hours. Based on the hx,
the pt most likely has:
A Sleep apnea
B Seizure disorder
C Cluster headache
D Migraine headache
E Transient ischemic attacks - ANSWERC
A 21-year-old pt is brought to the ED after having an episode of nausea, sweating and hematemesis.
The pr reports recently having severe HA and numbness in the extremities. CT scan reveals
generalized brain atrophy. Lab studies reveal evidence of RTA and a CPK of 3120 mcg/L. This
presentation is consistent with chronic use of which of the following?
A PCP
B Amphetamines
C Steroids
D Cocaine
E Inhalants - ANSWERE
A 22-month old is observed to place a wooden block on a toy train and say "choo-choo!" while
moving the block back and forth along a track. The behavior is most likely an example of which of the
following types of play?
A Fantasy
B Parallel
C Symbolic
D Cooperative
E Sensorimotor - ANSWERC
,A 23-year-old pt began psychotherapy due to feelings of inadequacy and depression in the context of
working in a coffee shop since graduating from college and deferring medical school acceptance. The
pt has been having conflicts with parents over his ambivalence about becoming a physician. Which of
the following is the most likely developmental task with which the patient is struggling?
A Identity
B Intimacy
C Mastery
D Productivity
E Generativity - ANSWERA
A 26-year-old medical student is struggling with time management and peer-peer interactions on
hospital rotations. The student has received feedback that she spends too much time organizing and
highlighting her pt care cards and writing and re-writing notes to the exclusion of spending time with
pts. She constantly violates duty hours b/c of seeming inability to complete her work during the day.
When given a group presentation assignment, she completed it on her own telling her peers, "it was
just easier to do it myself." Which of the following PD is most consistent with these symptoms?
A Antisocial PD
B Borderline PD
C Paranoid PD
D Narcissistic PD
E Obsessive-compulsive PD - ANSWERE
A 26-year-old patient presents with HA and clumsiness of the R hand for several weeks. PE is
noteworthy for difficulty with RAM on R hand, an overt intention tremor on finger to nose testing,
and mildly dysmetric finger tapping. CN intact and there is no pailledema. Damage to which of the
following structures will most likely be seen on MRI?
A. Medulla
B. Putamen
C. Cerebellum
D. Cisterna magna
E. Cerebellar tonsils - ANSWERC
RAM, coordination, clumsy= Cerebellum
,A 27-year-old patient is seen for intermittent muscle twitching. Exam demonstrates full strength with
normal muscle bulk. An EMG study demonstrates spontaneous discharges which are relatively
constant and represent firing of the motor unit. The findings are typical of
A cramps
B spasms
C myokymia
D fibrillations
E fasciculations - ANSWERE
cramp- sustained m. spasm
spasms- painful m. contractions
myokymia- lower eye lid muscle contractions
fibrillations- not visible, detectable by EMG
fasciculations- visable and detectable spontaneous/constant
A 32-year-old pt has episodes of irresistible sleepiness and falls asleep while driving. The pt reports
experiencing episodes of paralysis and hallucinations upon awakening. These symptoms are best
explained by a deficiency in which of the following?
A GABA
B Orexin
C Cortisol
D Melatonin
E Adenosine - ANSWERB
A 35-year-old pt is hospitalized b/c of concussion after a MVC. PE shows no abnormalities other than
minor lacerations and ecchymoses. One week later, the pt has generalized pain, dizziness, difficulty
sleeping and recurrent nightmares when able to sleep. The pt now fears driving. Which of the
following is the most likely explanation for the development of these sx?
A malingering
B adjustment disorder
C acute stress disorder
D somatic symptom disorder
E PTSD - ANSWERC
, A 65-year-old pt has fallen several times over the past six months. The pt's MSE is normal. Smooth
pursuit and saccadic movements are impaired, more prominently for vertical gaze, but full ROM is
easily elicited by doll's head maneuvers. The pt has mild symmetric rigidity and bradykinesia. There is
no tremor. A brain MRI is unremarkable as are the results of the CSF and routine labs including toxic
drug scree. Which of the following is the most likely dx?
A Corticobasal degeneration
B Olivopontocerebellar degeneration
C Idiopathic Parkinson's disease
D Primary progressive aphasia
E Progressive supranuclear palsy - ANSWERE
A 72-year-old developed sudden onset of memory loss, and was unaware of how the pt and spouse
arrived at the supermarket. The spouse noted the pt was able to drive without problem, but then
didn't remember the conversation. The entire episode lasted three hours, after which time the pt
returned to baseline. The most likely diagnosis is
A presyncope
B complicated migraine
C complex partial seizure
D transient global amnesia
E posterior circulation stroke - ANSWERD
A 72-year-old pt presents with subacute onset of progressive ataxia of gait and limbs. Lab tests reveal
the presence of anti-yo antibody. Which of the following tests should be ordered next?
A single photon emission CT scan of the brain
B CT scan of the chest, abdomen and pelvis
C MRI scan of brain
D serial titers of anti-yo antibody
E MRI of spine - ANSWERB
Paraneoplastic cerebellar degeneration (PCD)
Yo-yo, get a C/A/P CT
A breast feeding patient taking Sertraline wants to test her breast milk and the baby's blood for levels
of the drug. The physician explains to the pt that testing is not indicated. Which of the following is
the rationale for the physician's advice?
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