Show:
The Brain
Systemic Disease
Pharmacology
Numbness and Tingling
Miscellaneous
100
A 41-year old female presents to the ER complaining of a sudden onset of the "worst headache of my life". A stat CT of her head is found to be normal. This would be the most appropriate next step in diagnosis of the patient.
What is a lumbar puncture.
100
A 35 year old female presents with a 4 month history of dysarthria and muscle fatigue. She is a nurse and the end of work she has profound difficulty enunciating her words and producing a full smile. The symptoms resolve with rest. On exam she has ptosis of the left eyelid. You feel this is the most likely diagnosis.
What is myasthenia gravis
100
This is the most appropriate initial treatment of multiple sclerosis.
What is beta interferon
100
A 35 year old male underwent gastric bypass surgery 1 year ago and has lost 130 pounds. Since his surgery, he has eaten primarily vegetables and fruits. He comes to the office today because his feet sometimes feel odd like novocaine wearing off. You suspect the patient has this diagnosis.
What is pernicious anemia.
100
A 2 year old is brought to the office for follow up after a battery of tests including hearing test, EEG, and CT scan all of which are normal. The child's parents describe delayed speech development. The child has age appropriate motor skills, however his language and social development are severely delayed. The parents also note that the child has limited play skills and seems to be particularly sensitive to the environment (noise and motion). You suspect this diagnosis.
What is autism spectrum disorder.
200
A 58-year-old male presents to the office with a complaint of tremor in his right hand. Upon questioning, you discover that the tremor is getting worse and he is having trouble eating with a fork and buttoning his shirt. On your physical exam you notice bradykinesia, rigidity, and a shuffling gait. Based on these symptoms you diagnose your patient with this.
What is Parkinson's disease
200
A 65 year old male is brought to your clinic by his family because he has taken to wandering the streets. For the past 6 months he has been increasingly forgetful of names and places. He has become listless and has lost interest in his usual hobbies. Recently his decline accelerated. You suspect this diagnosis.
What is Alzheimer dementia
200
A patient diagnosed with Parkinson's with bradykinesia could best be treated with this medication
What is levodopa or amantadine or selective MAOIs
200
A 27 year old female with numbness and tingling of her right hand specifically her thumb, index and middle fingers. The symptoms are worse while working on the computer keyboard at work. She awakes at night occasionally with similar symptoms. You suggest this as the best approach to treating this condition
What is modify computer use, rest, wear wrist splints
200
A 78 year old female presents with low back pain that radiates to both legs. She states her legs get weak when she walks at the mall. You are most likely to find this on neurologic exam.
What is a normal exam.
300
This hereditary disorder is characterized by involuntary writhing and progressive dementia.
What is Huntington's disease
300
A 26-year-old female describes several episodes of weakness and numbness of her extremities. Each episode comes on acutely and resolves with residual symptoms within 1-3 days. Today she presents with imbalance in her gait. This would be the most beneficial diagnostic study.
What is MRI
300
A child exhibits short staring spells at school which are sometimes accompanied by loss of postural tone. Episodes last less than a minute. EEG reveals bilateral 3 Hz spike and wave pattern. You would choose this medication to treat the child.
What is ethosuximide or valproic acid (best for petit mal seizures)
300
A 62 year old obese female presents with progressive numbness and tingling of her feet for the past three months. On physical exam, the patient is found to have decreased sensation to pinprick and vibration, absence of ankle reflexes, and difficulty tandem walking. You suspect these symptoms are due to this underlying etiology.
What is diabetes mellitus
300
A 43 year old female complains of brief episodes of lancinating facial pain that starts at the left side of her mouth and radiates to the eye and ear. You suspect this diagnosis.
What is trigeminal neuralgia
400
An 18 year old female is transferred to your ER from a local college infirmary. She presented the day before with a headache but became confused and is now febrile. She has a petechial rash on physical exam. Her CSF has increased WBCs and protein, and a decreased glucose. You suspect this is the most likely organism responsible for her symptoms.
What is Neisseria meningitides
400
A 26 year old is brought to the ER by friends who state she is acting as if intoxicated. She denies any use of alcohol or drugs but states that her legs have become weak and tingling, causing progressively worsening difficulty walking for 2 days. She thought perhaps she had slept on them wrong as she has also been severely fatigued. Exam reveals tachycardia, an irregular rhythm, and hypotension. As she is waiting for a consult she becomes more fatigued and experiences incontinence of urine. You suspect she has this diagnosis.
What is Guillain Barre
400
A 50 year old female describes a feeling of restlessness and a curious sensory disturbance in her legs at night. These sensations often interrupt her sleep and have led to chronic fatigue and irritability. This class of medications is generally recommend for these symptoms.
What is anticholinergic medications
400
A 22 year old female presents to the ER with circumoral numbness and tingling. She feels anxious and is tachypneic. She states this came on suddenly and she is concerned that she is having a heart attack. ECG is normal. D dimer is negative. You suspect this is the underlying etiology
What is panic attack
400
A patient has a blind right eye. If sympathetic and parasympathetic innervation is intact, you would expect to see this on direct and consensual light reflex.
What is light in the left eye will cause both eyes to constrict, but right eye will have no effect.
500
A patient with progressive dementia, gait disturbance, urinary incontinence, and enlargement of the ventricles on CT scan as well as an absence of papilledema would most likely have this diagnosis.
What is normal pressure hydrocephalus
500
A 58 year old male with a chronic progressive neurologic disorder is being admitted to a long-term care facility. He is unable to walk. He has difficulty swallowing, chewing, and talking as well as cognitive deficits. Exam reveals stiffness and wasting of both upper and lower limbs but intact sensory function. His tongue appears wasted and exhibits fasciculations. You suspect this diagnosis.
What is ALS
500
A college student who has been under high stress studying for exams and applying to graduate school presents with facial pain and stiffness. The symptoms first began about 1 week ago. He states his eyes and mouth have become dry affecting his ability to study or eat. He is unable to close his left eye and an asymmetric grimace is noted. You recommend this as treatment.
What is lubricating eye drops, tape eye shut at night or cover with a patch.
500
A 55 year old right handed male presents with a 4 hour history of weakness and tingling of his right hand and numbness of the right side of his mouth. He had mild difficulty with word finding. His symptoms have improved since when they started, but his wife made him come to the ER. There is no significant PMH. You suspect this diagnosis.
What is TIA
500
Wernicke's encephalopathy can be a complication of chronic alcoholism and this deficiency.
What is vitamin B1 deficiency (thiamine)