Neurology Pharm
•Which of the following psychotropic medications from the patient’s medication list is associated with the presence of epileptiform abnormalities on the EEG?
A.Fluoxetine
B. Clozapine
C. Clonazepam
D. Valproic acid
E. Lamotrigine
B. Clozapine
Which of the following contribute to genetic susceptibility to late onset AD?
A. Presenilin gene mutations
B. Apolipoprotein E4 genotype
C. Amyloid precursor protein mutations
D. Angiotensin-converting enzyme gene mutations
E. A and C
B. Apolipoprotein E4 genotype
58 year old man was brought by ambulance to the ED. 20 minutes earlier he fell to the ground, unable to move his right leg and arm, and was making sounds but could not speak coherently. On exam, you identify right sided hemiparesis and expressive aphasia. Which of the following imaging tests would you order first to rule out a suspected ischemic stroke, and what would you expect to see?
A. MRI: DWI hyperintensity and apparent diffusion coefficient (ADC) hypointensity in the left MCA territory
B. MRI: DWI hyperintensity and ADC hyperintensity in the left MCA territory
C. CT: normal exam
D. MRI: DWI hyperintensity normal ADC and T2 hyperintensity in the left MCA territory
E. CT: hyperdense cortical signal in the left MCA territory
Answer: CT normal exam
Although in the context of an acute stroke you might observe DWI hyperintensity and ADC hypointensity, the first test to order in an emergency setting is a CT to r/o a hemorrhagic stroke and then start tPA promptly. A hyper acute stroke (minutes from the beginning of symptoms) will often show as a normal non-contrast head CT, though later in time (1-3 hours), clinicians might observe cortical hypodensity and effacement of the gray-white matter border, signaling edema.
Which of the following is BEST defined as an injury to another party that gives rise to a right on the part of the injured person to sue for damages?
A. Malfeasance
B. Misdiagnosis
C. Negligence
D. Privilege
E. Tort
E. Tort
A tort is an injury to another party that gives rise to a right on the part of the injured person to sue for damages. Personal injury or tort law embodies the principle that a person injured by the acts of another should receive compensation for the harm done. This concept dates back more than 2,000 years.
Which of the following are reasons that make it difficult to detect abuse in the elderly?
A. The elderly are often too frail to advocate for themselves
B. The perpetrator is most likely a family member and the victim doesn’t want to implicate them
C. Signs of abuse may be mistaken for signs of illness
D. Dementia, if present, can interfere with a victim’s ability to assess her own situation
E. Financial exploitation is not typically presented in a clinical exam
F. All of the above
F. All of the above
Which of the following medications should be avoided in a patient with GAD and focal epilepsy, due to the possibility of seizure exacerbation
A. Clonazepam
B. Bupropion
C. Buspirone
D. Sertraline
E. Pregabalin
B. Buproprion
Anterior capsulotomy has been demonstrated to be effective in cases of treatment failure with which of the following severe disorders?
A. Tourette's syndrome
B. Schizophrenia
C. Bipolar Disorder
D. Antisocial Personality Disorder
E. Obsessive-Compulsive Disorder
F. Major Depressive Disorder
G. Generalized Anxiety Disorder
E.
Also known as subcaudate tractotomy, this psychosurgery has proven effective for intractable OCD. Cingulotomy is another common psychosurgical procedure for extreme OCD and is 25-30% effective in otherwise treatment-unresponsive patients.
Which of the following conditions do not typically cause multiple ring-shaped lesions?
A. Abscess
B. Toxoplasmosis
C. Cysticercosis
D. Metastases
E. Primary brain tumors
E. Primary brain tumors
Primary brain tumors, such as glioblastomas and astrocytomas, typically cause only single lesions, which may have a ring shape. The other conditions typically cause multiple ring-shaped lesions. The history, nonneurologic findings, blood tests, or, if necessary, a biopsy usually allow a diagnosis.
Which of the following is BEST considered as an unintentional tort?
A. Assault
B. Battery
C. False imprisonment
D. Misdiagnosis
E. Undue familiarity
D. Misdiagnosis
In psychiatric malpractice claims, typical intentional torts are battery, assault, false imprisonment, abandonment, intentional infliction of emotional distress, and undue familiarity.
True or False. Competent patients with a reversible illness have the right to refuse any treatment, including life-saving treatments.
True.
A 28-year-old surgical intern, fighting off the effects of sleep-deprivation, drinks at least three cups of coffee each day. Her strategy allows her to work, sleep, and socialize. Various professional and social stressors eventually drive her to psychiatric counseling. A psychiatrist begins psychotherapy and prescribes fluvoxamine. Rather than improving, the intern develops anxiety, palpitations, insomnia, and sometimes a fine tremor. Which is the most likely explanation of her new symptoms?
A. The fluvoxamine causes panic attacks.
B. The fluvoxamine and psychotherapy cannot overcome her professional and social stressors.
C. The addition of fluvoxamine to her caffeine-fueled existence led to caffeinism.
D. She has developed exhaustion from physical and psychologic stress.
C. The addition of fluvoxamine to her caffeine-fueled existence led to caffeinism.
Her new symptoms are manifestations of caffeine intoxication, which developed because fluvoxamine inhibited the enzymes that metabolize caffeine. In other words, the inhibition of the metabolizers increased the substrate. Many other SSRIs and SNRIs do not pose this risk.
A man with no neurologic symptoms requests DNA testing of his ApoE status, and finds out that he has two ApoE4 alleles. What is the most likely consequence of his learning this result?
A. Onset of depressive symptoms
B. Onset of anxiety
C. Increased suicide ideation
D. No significant short-term psychological risks
E. Increase in obsessive thinking.
D. No significant short-term psychological risks
d. Neurologists discourage individuals, even those with early dementia, from undergoing ApoE testing because no preventative or curative treatments are available for Alzheimer disease. Many neurologists had forecast that patients receiving such results would develop anxiety, depression, and suicidality. However, studies show that patients learning that they carry ApoE4 alleles demonstrate no significant short-term psychological risks.
•Which of the following EEG abnormality/abnormalities is/are most likely to be seen with epilepsy?
A. A generalized delta slowing
B. A reactive alpha posterior dominant rhythm
C. Left temporal theta slowing
D. Right frontal spike and slow wave discharges
E. Excessive beta activity
F. A and B
G. B and C
H. A and C
I. B and E
J. C and E
D Right frontal spike and slow wave discharges.
Robert is arrested for assault and held in prison. Due to disorganized behavior, a psychiatric evaluation is conducted by a forensic psychiatrist to determine Robert's fitness to stand trial. Robert reports that 1 month earlier he was evaluated in a local emergency room for hearing voices. What is the difference between the evaluation done by the forensic psychiatrist and the evaluation done by the emergency room psychiatrist.
A. Only the ER evaluation requires a full medical history.
B. Only the forensic evaluation contains details on Robert's memory.
C. The foresensic psychiatrist does not establish a doctor-patient relationship with Robert.
D. The ER evaluation will be the only one to contain medical recommendations.
E. Only the ER evaluation contains details on Robert's memory.
F. The ER psychiatrist does not establish a doctor-patient relationship with Robert
Answer C
When a forensic psychiatrist is evaluating a patient, they do so for a third party, usually the court. Therefore, there is no assumption of confidentiality.
A psychiatrist routinely receives free dinners, play tickets, and short trips from a pharmaceutical company. Which of the following statements concerning this situation is correct?
A. This situation does not represent a conflict of interest for the psychiatrist.
B. There is no evidence that gifts influence physicians' behavior.
C. This situation is ethical if no single gift is worth more than $500
D. Self regulation by physicians is the least effective way to deal with this issue.
E. Wheres doctors are not influenced by this behavior, support staff such as nurses physicians' assistants, and secretaries are.
D. Accepting gifts from drug reps is a conflict of interest and ethically questionable.
Carbamazepine is often used in the treatment of epilepsy patients with comorbid depression. Which of the following medications has a chemical structure most similar to carbamazepine?
A. Lithium
B. Phenytoin
C. Imipramine
D. Haloperidol
E. Phenelzine
F. Tranylcypromine
C. Imipramine
Which CSF pattern is a marker for Alzheimer disease?
A. Low Aβ and low tau protein concentrations
B. High Aβ and high tau protein concentrations
C. Low Aβ and high tau protein concentrations
D. High Aβ and low tau protein concentrations
A. Low Aβ and low tau protein concentrations
Asymptomatic as well as symptomatic individuals with Alzheimer disease show low Aβ and high tau protein CSF concentrations. Detection of the illness in an early stage may allow medical intervention to prevent the onset of dementia. In the proper clinical setting, neurologists could diagnose the presymptomatic stage of Alzheimer disease on the basis of these and other laboratory findings.
In 72 year old, suspect Alzheimer's pathology and you order MRI scan, which shows bilateral hippocampal atrophy and periventricular T2 hyper-intensities. Which of the following additional imaging test(s) could you order and what would you expect to see to confirm you hypothesis of a neurodegenerative etiology?
A. Magnetic resonance spectroscopy (MRS): decreased GABA and increased Tau in the hippocampi
B. 15O-H2-O PET: decreased perfusion in the frontal lobes
C. Diffusion tensor imaging (DTI): reduced fractional anisotropy (FA) in the fimbria and cingulate bundle
D. FDG-PET: reduced uptake in the mid-temporal lobe, posterior cingulate, and parietal cortex
E. SPECT: increased beta-amyloid depositions in the hippocampi and fimbria
F. A and C
G. A, B, C
H. D and E
I. B and E
J. A and E
D. FDG-PET: reduced uptake in the mid-temporal lobe, posterior cingulate, and parietal cortex
True or False. The psychiatrist or inpatient unit is liable if a suicidal patient is refused further insurance coverage for inpatient hospitalization, is discharged, and then commits suicide.
True. The psychiatrist or inpatient unit is liable if a suicidal patient is refused further insurance coverage for inpatient hospitalization, is discharged, and then commits suicide. A psychiatrist's duty to his or her patient continues, regardless of whether the patient's insurer will continue to pay for services.
A patient with terminal lung cancer is placed in hospice care. The patient is grimacing in pain, and the nurse continues to administer small doses of morphine even though the patient’s breathing is noticeably slowing. What ethical principal justifies this action?
A. Informed consent
B. Multiple agentry
C. Double effect
D. Therapeutic privilege
E. Cultural relativism
Answer: C
The principle of double effect justifies taking an action with foreseeably harmful effects (respiratory compromised) if the act itself is aimed at promoting good (causing relief of pain) and the good effect outweighs the bad effect (aimed for pain relief in a hospice patient with a terminal illness).
Informed consent – make patient aware of the risk and benefits or proposed treatment
Multiple agentry – refers to a physician having duties to interested parties beyond an individual patient
Therapeutic privilege – a principle justifying withholding relevant clinical information from a patient if disclosing that information would cause harm
Cultural relativism – a principle stating that an individual’s morality should be judged according to their own cultural context and not by the standards of an outside culture
A 52-year-old woman suffered from focal seizures with impaired consciousness that began when she was a teenager. Multiple AED regimens had produced mental dulling and other side effects, and still allowed one or two seizures each week. One year before a psychiatric consultation she underwent partial left temporal lobectomy for seizure control. Subsequently, she remained seizure-free even without any AEDs. However, she developed postoperative anxiety, fearfulness, dysphoria, and “moodiness.” CCTV-EEG monitoring during this time showed no epileptic activity. Which would be the best strategy to restore her preoperative mental status?
A, Prescribe an antidepressant
B. Prescribe an anxiolytic
C. Reinstitute an AED, such as valproate
D. Install a vagus nerve stimulator
E. Observation, no further pharmacologic interventions at this time.
F. Prescribe an antipsychotic
C. Reinstitute an AED, such as valproate
Following neurosurgical removal of a seizure focus in the temporal lobe, many patients experience postoperative psychiatric complications, particularly personality changes and depression. Psychosis sometimes emerges, but usually only if seizures recur. Although this patient probably is not experiencing seizures, a mood-stabilizing AED would probably reestablish her equilibrium
During combat, a soldier loses both eyes. Without external clues, which circadian rhythm will he most likely follow?.
A. A conventional 24-hour sleep–wake cycle
B. A progressively shorter cycle
C. A steady 24.5- to 25-hour cycle
D. A random sleep–wake cycle
C. A steady 24.5- to 25-hour cycle
Without external clues, the soldier will most likely follow a 24.5- to 25-hour cycle. This pattern is the same circadian rhythm that volunteers follow when they “free run” while isolated in caves during experiments.
Which one of the following intracranial structures will be readily recognizable on CT but almost invisible on MRI?
A. Temporal lobe hematoma.
B. Porencephaly.
C. Calcified pineal gland.
D. Toxoplasmosis.
E. Meningioma.
C. Calcified pineal gland
Calcified objects that lack water, such as calcium in a choroid plexus, congenital infections, and a calcified pineal gland, will emit little or no signal on MRI without using special sequences. However, their calcium, which is radio-dense, blocks the ionizing radiation of CT and thus allows for detection of these anatomic and pathologic findings.
True or False. The patient's signature on a consent form constitutes informed consent.
False.
If a patient with diminished capacity is known to clinicians as a Jehovah’s Witness who has previously expressed his intention to refuse blood transfusion, clinicians may omit transfusion on grounds of_____
Implied Refusal