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100
Pallidotomy is surgical therapy for 1. Alzeimers disease 2. Pakinson,s disease 3. Huntington,s chorea 4. Vascular dementia 5. Temporal lobe epilepsy
B. Parkinsons disease Thallomotomy and pallidotomy, contralateral to the side of the body that is most affected, are most effective for the treatmment of disabling unilateral tremor and dyskinesis from Parkinson,s disease.
100
Compared to children with attention-deficit/hyperactivity disorder (ADHD), adults with ADHD: (check one) A. Tend to be more hyperactive B. Tend to be less impulsive C. Are less likely to have corroboration of symptoms by family members D. Are less likely to complain of inattention difficulties
.B. Tend to be less impulsive Longitudinal studies of young people diagnosed with attention-deficit/hyperactivity disorder (ADHD) show that symptoms of hyperactivity and impulsivity may decrease with age, but inattention tends to persist. Studies of clinically referred adults with ADHD show that about half have clinically important levels of hyperactivity and impulsivity and up to 90% have prominent attentional symptoms. Like some youth with ADHD, adults with ADHD tend to have additional cognitive deficits, specifically executive function deficits, which include problems encoding and manipulating information and difficulties with organization and time management. Research shows that using retrospective self-reports of adults is a valid method of diagnosing ADHD. Studies have shown that the consistent reporting of childhood ADHD symptoms by both adults and their parents is highly correlated. Research has also found strong agreement between the self-reports of adults and their partners regarding ADHD symptoms. Ref: Wilens TE, Faraone SV, Biederman J: Attention-deficit/hyperactivity
100
The earliest presenting symptom in most older patients with open-angle glaucoma is: (check one) A. Unilateral eye pain B. Unilateral eye redness C. Unilateral visual loss D. Tunnel vision E. Double vision
D.Tunnel vision About 3% of persons over age 55 have glaucoma, making it a leading cause of vision impairment. Although it is usually asymptomatic, the most common presenting symptom is tunnel vision, a gradual loss of peripheral vision. Ref: Distelhorst JS, Hughes GM: Open-angle glaucoma. Am Fam
100
Symptoms that present the greatest concern in pregnant women include A) Visual disturbances B) Nausea C) Heartburn D) Abnormal cravings E) Mild edema
What is A) Visual disturbances?
100
Which of the following is not considered in deciding to screen for conditions in the elderly? A) The exact age of the patient B) The risk of dying from the condition C) The potential benefits of screening D) The direct and indirect harms of screening E) The patient’s values and preferences
What is A) The exact age of the patient?
200
In differentiating early Parkinson’s disease from variants such as drug-induced parkinsonism, progressive supranuclear palsy, and multiple system atrophy, which one of the following is the most important clue? (check one) A. A resting tremor B. Bradykinesia C. Rigidity D. Gait difficulty E. Loss of postural reflexes
B. Parkinson,s Disease Resting tremor is the most common presentation of Parkinson,s disease. It is rare in progressive supranuclear palsy and multisystem atrophy, and less common in drug induced
200
Over the past year, a 27-year-old female has had marked feelings of anxiety, tension, and irritability during the week preceding most menstrual cycles, accompanied by extreme fatigue and insomnia. She has regularly missed several days of work each month because of fatigue. She has no previous history of any health or mental problems, and within a few days of the onset of her period she is back to normal. Which one of the following is true concerning this condition? (check one) A. Neither biologic nor psychological factors play a part in this condition B. This condition is a variation of a depressive disorder C. Oral contraceptive pills are consistently effective in the treatment of this condition D. This problem can be effectively treated with serotonergic antidepressants E. Alprazolam (Xanax) is an effective first-line agent for treatment of this condition
D. This problem can be effectively treated with SSRI,S Women with premenstrual dysphoric disorder (PMDD) experience a cluster of mood, cognitive, and physical symptoms that recur in the luteal phase of the menstrual cycle and remit in the follicular phase. Multiple rigorously conducted, placebo-controlled, randomized trials have consistently shown the value of SSRIs, especially if administered during the luteal phase of the menstrual cycle. Among women whose mothers have been affected by PMS, 70% have PMS themselves, compared with 37% of women whose mothers have not been affected. Because many patients with PMDD do not have depressive symptoms, this disorder should not be considered as simply a depressive variant. Some studies have shown that symptoms actually worsen with the administration of oral contraceptive pills. Because of the potential for drug dependence, high-potency benzodiazepines such as alprazolam should be used only as second-line drug therapy if an optimal response is not achieved with an SSRI. Ref: Johnson SR: Premenstrual syndrome therapy. Clin Obstet Gynecol 1998;41(2):405-421. 2) Bhatia SC, Bhatia SK: Diagnosis and treatment of premenstrual dysphoric disorder. Am Fam Physician 2002;
200
997Approximately 30%–50% of infants born to Chlamydia-positive mothers will have: (check one) A. Conjunctivitis B. Dermatitis C. Jaundice D. Pneumonia E. Urogenital infection
A.Conjunctivitis Chlamydial genital infection is reported in 5%–30% of pregnant women, with vertical transmission to >50% of their infants at birth. An infant born to a mother with active chlamydial infection has a 50%–70% risk of acquiring infection at any anatomical site. Approximately 30%–50% of infants born to Chlamydia-positive mothers will develop conjunctivitis, and at least 50% of these children will also have nasopharyngeal infection. Infants born to women with chlamydial infection may also develop associated pneumonia, but this affects only 10%–20% of this population. Ref: Peipert JF: Genital chlamydial infections. N Engl J Med 2003;349(25):2424-2430. 2) Behrman RE, Kliegman RM, Jenson HB (eds): Nelson Textbook of Pediatrics, ed 17. Saunders, 2004, p
200
A 24-year-old female is noted to have the presence of trichmonas found on a routine pap smear that is perform at the student health center. Although the center diagnoses a number of cases each year, she is entirely asymptomatic. Appropriate management should be to A) Reassure patient that no treatment is necessary B) Repeat cultures after the next menstrual cycle and treat if the organism is present C) Treat only if the patient is pregnant D) Treat regardless of symptoms E) Treat only if symptoms are present
What is D) Treat regardless of symptoms?
200
A 75 year old gentleman is brought in to your office by his wife. She complains that he is not the same over the last six months. His memory is failing him, he has difficulty with walking (especially when he initiates walking) and he is incontinent of urine. Which of the following is the most likely diagnosis based on his history? A) Alzheimer’s disease B) Parkinson’s disease C) Normal pressure hydrocephalus D) Pick’s disease E) Progressive supranuclear palsy
What is C) Normal pressure hydrocephalus?
300
.Which one of the following is useful in migraine prophylaxis? (check one) A. Cyanocobalamin (vitamin B12) B. Riboflavin (vitamin B2) C. Ascorbic acid (vitamin C) D. Cholecalciferol (vitamin D) E. Tocopherol (vitamin E)
B. Riboflavin A daily oral dose of 400 mg of riboflavin has been shown to be superior to placebo for migraine prophylaxis. The effect of riboflavin begins after 1 month of treatment and is maximal after 3 months of treatment. Its effect is most pronounced on attack frequency and the number of days patients have a headache. Ref: Schoenen J, Jacquy J, Lenaerts M: Effectiveness of high-dose riboflavin in migraine prophylaxis: A randomized controlled trial. Neurology 1998;50(2):
300
You are consulted for medical management of a 45-year-old male, previously unknown to you, who is hospitalized in the psychiatric unit with paranoid schizophrenia. His fasting blood glucose level is 180 mg/dL. Which one of the following medications is the most likely cause of the hyperglycemia? (check one) A. Alprazolam (Xanax) B. Haloperidol (Haldol) C. Chlorpromazine (Thorazine) D. Olanzapine (Zyprexa) E. Thiothixene (Navane)
YoThe atypical antipsychotics include clozapine, olanzapine, risperidone, ziprasidone, quetiapine, and aripiprazole. As a class, they have fewer extrapyramidal side effects than the classical antipsychotics haloperidol, thiothixene, chlorpromazine, and others. Some of the atypical agents, notably olanzapine and clozapine, have been associated with hyperglycemia and the development of type 2 diabetes mellitus. Neither benzodiazepines like alprazolam nor the classical antipsychotics have been associated with hyperglycemia. Ref: Aripiprazole (Abilify) for schizophrenia. Med Lett Drugs Ther 2003;45:15-16. 2) Leslie DL, Rosenheck RA: Incidence of newly diagnosed diabetes attributable to atypical antipsychotic medications. Am J Psychiatry 2004;161(9):1709-
300
syndromeYou are the team physician for the local high-school swim team. Over the past week, seven members of the team have developed both folliculitis and outer ear infections. You suspect bacterial contamination of the swimming pool. Which one of the following is the most likely cause? (check one) A. Streptococcus pneumoniae B. Pseudomonas aeruginosa C. Corynebacterium ulcerans D. Staphylococcus epidermidis E. Escherichia coli
B. Psuedomonas Aeruginosa Athletes, including swimmers, are susceptible to a number of skin infections. The pH of the external ear is normally acidic. Continued water exposure raises the pH, creating conditions for bacterial overgrowth, most often caused by either Pseudomonas aeruginosa or Staphylococcus aureus. Swimming pool folliculitis is most often attributed to colonization of water with P. aeruginosa. Ref: Fiorillo L, Zucker M, Sawyer D, et al: The pseudomonas hot-foot
300
Which of the following bacterial infections is not generally associated with preterm labor? A) Ureaplasma urealyticum B) Mycoplasma hominis C) Gardnerella vaginalis D) Bacteroides species E) All are associated with preterm labor
What is E) All are associated with preterm labor?
300
An 85 year old gentleman complains of chronic insomnia. Based on study results you know that A) Insomnia is relatively rare in the elderly B) Insomnia is a natural progression of aging and has little effect on the well-being of elderly patients C) Chronic insomnia is an independent risk factor for cognitive decline in elderly men D) Insomnia has no impact on the risk of falls E) Insomnia does not lead to nursing home placement
What is C) Chronic insomnia is an independent risk factor for cognitive decline in elderly men?
400
Which one of the following is a common early side effect of fluoxetine (Prozac)? (check one) A. Constipation B. Loss of appetite C. Orthostatic hypotension D. Atrioventricular block E. Skin rash
B. Loss of apetitite Fluoxetine, a selective serotonin reuptake inhibitor, has no effect on the norepinephrine system; therefore, it does not produce the side effects common to the tricyclic antidepressants. These include anticholinergic side effects (dry mouth, constipation), orthostatic hypotension, cardiac conduction disturbances, and drowsiness. Loss of appetite is often seen in patients who take fluoxetine, and can be especially troublesome in the elderly. Skin rash is uncommon. Ref: Tasman A, Kay J, Lieberman JA (eds): Psychiatry. WB Saunders Co, 1997, pp 1616-1619. 2) Physicians’ Desk Reference, ed 54. Medical
400
2003Which one of the following antidepressants is LEAST likely to cause sexual dysfunction? (check one) A. Bupropion (Wellbutrin) B. Sertraline (Zoloft) C. Fluoxetine (Prozac) D. Imipramine (Tofranil) E. Trazodone (Desyrel)
A.BUPROPION Sexual dysfunction, including decreased libido, ejaculatory disturbance, and anorgasmia, is common with the SSRIs (e.g., sertraline and fluoxetine). Tricyclic antidepressants such as imipramine also cause sexual dysfunction. Trazodone can cause priapism. Only bupropion is relatively free of sexual side effects. Ref: Rakel RE, Bope ET (eds): Conn’s Current Therapy 2005. Saunders, 2005, pp 1273-1279. 2) Ables AZ, Baughman OL III: Antidepressants: Update on new agents and indications. Am Fam Physician
400
Current U.S. Preventive Services Task Force recommendations for preventing dental caries in preschool-aged children include which one of the following? (check one) A. Primary care clinicians should prescribe oral fluoride at currently recommended doses to all preschool-aged children B. Oral fluoride is not necessary if the primary water source contains adequate fluoride C. Oral fluoride supplementation should begin at birth when indicated D. Evidence for fluoride supplementation is insufficient to recommend for or against its use
B.Oral fluoride is not necessary if the primary water source contain adequate fluoride The U.S. Preventive Services Task Force (USPSTF) recommends that primary care clinicians prescribe oral fluoride supplementation at currently recommended dosages to preschool-aged children older than 6 months of age whose primary water source is deficient in fluoride. The USPSTF concluded that the benefits of caries prevention outweigh the potential harms of dental fluorosis. The USPSTF also concluded that there is insufficient evidence to recommend for or against routine risk assessment of preschool-aged children for dental disease prevention. Ref: U.S. Preventive Services Task Force:
400
A 27-year-old asymptomatic pregnant woman is found to have hyperthyroidism. Which of the following medications is the drug of choice for treatment? A) Propylthiouracil B) Radioactive iodine C) Methimazole D) Propranolol E) Levothyroxine
What is A) Propylthiouracil?
400
Which of the following is true regarding respiratory rate in the elderly? A) Subtle differences in age adjusted respiratory rate are present and should be adjusted for in the evaluation of the elderly patient B) Respiratory rates in the elderly are 5% higher than age adjusted controls C) Respiratory rates and patterns do not change as the patient ages D) Elevated respiratory rates do not represent concern in the elderly patients E) Respiratory rates do not correlate with disease in elderly patients
What is D) Elevated respiratory rates do not represent concern in the elderly patients?
500
Which one of the following sleep disorders is in the general class of circadian sleep disorders and may respond to bright-light therapy? (check one) A. Shift-work insomnia B. Alcohol-dependent sleep disorder C. Inadequate sleep hygiene D. Sleep-related myoclonus
A. Shift work insomnia. Shift-work insomnia is the only circadian sleep disorder listed. It may respond to bright-light therapy. Alcoholism is a behavioral disorder that may respond to gradual discontinuance. Inadequate sleep hygiene (use of stimulants at night, sleeping other than at bedtime, etc.) may respond to habit changes. Sleep-related myoclonus is an intrinsic sleep disorder and can be treated with levodopa or clonazepam. Ref: Sadock BJ, Sadock VA (eds): Kaplan & Sadock’s Comprehensive Textbook of Psychiatry, ed 8. Lippincott Williams & Wilkins, 2005, pp 2023-2030. 2) Kasper DL, Braunwald E, Fauci AS, et al (eds): Harrison’s Principles of Internal
500
The mother of a 3-year-old male is concerned that he doesn’t like being held, doesn’t interact much with other children, and rarely smiles. Of the following, which feature would be most helpful in distinguishing Asperger’s syndrome from autism in this patient? (check one) A. Normal language development B. Delayed gross motor development C. Repetitive fine motor mannerisms D. Preoccupation with parts of objects E. Focused patterns of intense interest
A.NORMAL LANGUAGE DEVELOPMENT. The DSM-IV categorizes Asperger’s syndrome and autism as pervasive developmental disorders. In both conditions, children have significant difficulties with social interactions, although the impairment is more severe and sustained in autism. Both Asperger’s and autism may be associated with symptoms of repetitive motor mannerisms, restricted patterns of interest (which are abnormal in focus or intensity), or preoccupation with parts of objects. However, unlike children with Asperger’s syndrome, autistic children have serious problems with communication skills, either in the development of speech itself or in the ability to carry on a conversation. Normal, age-appropriate language skills in a 3-year-old would rule out a diagnosis of autism. It is an important distinction to make, as the prognosis for independent functioning in children with Asperger’s syndrome is significantly better than in children with autism. Ref: Sadock
500
251A 42-year-old African-American male recently traveled to the Caribbean for a scuba diving trip. Since his return he has noted brief intermittent episodes of vertigo not associated with nausea or vomiting. He is concerned, however, because these episodes occurred after sneezing or coughing and then a couple of times after straining while lifting something. He has had no hearing loss, and no vertigo with positional changes such as bending over or turning over in bed. The most likely cause of this patients vertigo is (check one) A. vestibular neuronitis B. Menieres disease C. benign paroxysmal positional vertigo D. a perilymphatic fistula E. multiple sclerosis triggered by a rapid change in climate
D.Perilymphatic fistula A perilymphatic fistula between the middle and inner ear may be caused by barotrauma from scuba diving, as well as by direct blows, heavy weight bearing, and excessive straining (e.g., with sneezing or bowel movements.) This patients recent trip involved two of these potential factors. Vestibular neuronitis is a more sudden, unremitting syndrome. Menieres disease is manifested by episodes of vertigo, associated with hearing loss and often with nausea and vomiting. Benign paroxysmal positional vertigo is more likely in older individuals, and is associated with postural change. Multiple sclerosis requires symptoms in multiple areas and is not thought to be provoked by climate change. Reference: Labuguen RH: Initial evaluation of vertigo. Am Fam Physician 2006;73(2):244-
500
Which of the following statements about molar pregnancy is true? A) Malignant transformation is monitored by serial alpha-fetoprotein levels. B) Further pregnancies should be discouraged after a molar pregnancy. C) It is usually associated with hyperemesis gravidarum. D) Risk for recurrent molar pregnancy is not increased in women who have had previous molar pregnancies. E) The majority of molar pregnancies result in malignant transformation.
What is C) It is usually associated with hyperemesis gravidarum?
500
Which one of the following statements about rehabilitation after a stroke is true? A) Physical therapy should be instituted for stretching and strengthening once supporting muscles are strong enough to support appropriate loads B) Tennis ball exercises can be used to strengthen the hand muscles C) Most motor function improvement occurs more than 6 months after a cerebral vascular accident D) A walking cane used on the side affected can help with ambulation and balance E) Bladder or bowel incontinence has no effect on prognosis after stroke
What is A) Physical therapy should be instituted for stretching and strengthening once supporting muscles are strong enough to support appropriate?