Show:
SEIZURES
SLEEP DISORDERS
FIND THE LESION
DEMENTIA
MISCELLANOUS
100
A 40-year-old patient presents with new onset of seizures characterized by bilateral thrashing movements of the arms and legs. Which of the following would suggest a non-epileptic etiology of these events?
A. Tongue Biting B. Postictal confusion C. Eyes remain open D. Urinary Incontinence E. Following Commands
100
Stage II sleep is characterized by which of the following EEG findings?
a) slow rolling eye movements b) posterior dominant alpha waves c) K complexes and sleep spindles d) sawtooth waves due to eye movements e) high voltage slow waves during 50% of the recording
100
A 75 year old patient is evaluated for progressive gait imbalance, urinary incontinence and cognitive decline. After removal of cerebrospinal fluid there is noticeable improvement in gait and balance. CT scan of the patient’s brain obtained before lumbar puncture would likely show which of the following?
a) Cerebellar atrophy b) Enlargement of the frontal horns c) Hypodensity in the left hemisphere d) Increased intensity in the basal ganglia e) Crescent shaped hyperintensity over the right hemisphere
100
The psychiatrist evaluates an 80-year-old patient with no prior psychiatric history. The patient reports being more forgetful of family names gradually over the last year, and beginning to have difficulty managing activities of daily living. However the patient continues to conduct routine social activities with characteristic grace and etiquette, so that casual acquaintances fail to notice any abnormality or impairment during brief social encounters. Which of the following is the most likely diagnosis?
A. Vascular dementia B. Alzheimer dementia C. Frontotemporal dementia D. Dementia with Lewy bodies E. Normal pressure hydrocephalus
100
Which of the following medications is an appropriate initial treatment of absence seizures in children?
A. Gabapentin B. Vigabatrin C. Phenytoin D. Valproate E. Carbamazepine
200
An 8-year-old girl with inattention at school has an electroencephalogram (EEG). The recording shows a normal background rhythm with a generalized spike-and-wave pattern at 4 cycles per second. Which of the following is the most likely diagnosis?
A. Infantile spasms B. Benign Rolandic Epilepsy C. Juvenile Myoclonic Epilepsy D. Childhood Absence Epilepsy E. Localization-related epilepsy
200
A 35 year old patient has recurrent episodes of abrupt awakening from sleep. The patient’s spouse reports that these episodes typically begin with the patient sitting up in bed with a panicked scream. The patient appears to experience intense inconsolable fear with sweating and racing heart beat. The episodes resolve with the patient falling back to sleep. The patient cannot remember these episodes or any dreams the next morning. The patient does not experience anxiety during the day, but reports that work performance is beginning to be affected due to daytime drowsiness. Initial laboratory evaluation, including serum and urine toxicology, does not reveal any abnormalities, nor does an EEG. These symptoms are most consistent with which of the following disorders?
a) Panic b) Nightmare c) Sleep terror d) Sleep walking e) REM sleep behavior
200
The clock drawing in the image is consistent with a lesion in which of the following areas of the brain?
a) Brainstem b) Cerebellum c) Frontal lobe d) Parietal lobe e) Temporal lobe
200
Which of the following is the most specific factor for distinguishing delirium from Alzheimer dementia?
A. Apraxia B. Sleep disturbance C. Fluctuating arousal D. Visual hallucinations E. Short-term memory deficits
200
The capacity to inhibit behavioral responses improves over the course of adolescence most likely because of:
A. Attenuation of the reward circuitry B. Maturation of the prefrontal cortex C. Increased amygdala activation D. Synaptic pruning in the parietal cortex E. Synaptogenesis in the occipital cortex
300
The electroencephalography (EEG) finding of 4-6 Hz irregular polyspike activity in a patient with generalized seizures is characteristic of which of the following forms of epilepsy?
A. Absence B. Benign Rolandic C. Partial Complex D. Juvenile Myoclonic
300
Which of the following measures of REM is typically reduced in MDD?
a) Total density of REM b) Total time in REM sleep c) Sleep onset to REM onset d) Duration of the first REM period e) Average interval between REM periods
300
Nonfluent, effortful speech with decreased output is often associated with lesions of which of the following cortical structures?
a) Insula b) Occipital gyrus c) Angular gyrus d) Interior frontal gyrus e) Superior temporal gyrus
300
A 74-year-old, right-handed patient presents with significant memory loss, expressive aphasia, and left planar extensor response. The most likely diagnosis is:
A. Vascular dementia B. Dementia with Lewy bodies C. Alzheimer dementia D. Frontotemporal dementia E. Dementia due to normal pressure hydrocephalus
300
DAILY DOUBLE!!!
A patient who is an IV heroine user presents to the ED with several days of malaise, and severe aching back pain at the mid throacic level. Movement of the back is painful and the patient avoids it as much as possible. The morning of the visit to the ED the patient developed urinary incontinence and weakness of both legs associated with loss of sensation below the level of the pain. On examination, the patient has point tenderness over the 5th throacic vertebra, parparesis and sensory loss to all modalities below the level of the nipples. Which of the following is the most likely diagnosis? a) Anterior spinal artery infarct b) Acute transverse myelitis c) Spinal epidural abscess d) Paraneoplastic myelitis
400
A 16 year old patient is brought to the psychiatrists attention after having a single grand mal seizure. The patient’s parents have noted that on occasion the patient has sudden jerks of the entire body, which have resulted in dropping objects and being labeled as clumsy. The EEG shows rare 4-6 Hz irregular polyspike and wave bursts. The most likely diagnosis is:
a. Dysrhythmia with drop attacks b. Juvenile Myoclonic epilepsy c. Non eplieptic seizures d. Complex partial seizures e. Petit mal epilepsy
400
Which of the following sleep stages is the most important in restoring the altered functions that result from prolonged sleep deprivation?
a) REM b) Stage 1 c) Stage 2 d) Stage 3 e) Stage 4
400
Contralateral leg weakness with sparing of the face and arm associated with urinary incontinence and abulia are typical for stroke in the territory of which of the following arteries?
a) basilar b) carotid c) middle cereberal d) anterior cerebral e) posterior cerebral
400
Over the course of several months, a 46-year-old patient with no past psychiatric history becomes emotionally labile and irritable. The patient undergoes personality changes, and is observed to inappropriately laugh when neighborhood children taunt a stray cat. Within 2 years, the patient develops a fear of contamination and greatly decreases food intake due to being convinced that all food has germs. Memory is preserved. The patient is no longer able to work or live independently. Neuropsychiatric tests show impaired language and attention. Which of the following is the most likely diagnosis?
A. Schizophrenia B. Alzheimer disease C. Frontotemporal dementia D. Dementia with Lewy bodies E. Obsessive-compulsive disorder (OCD)
400
A 70-year-old patient presents with confusion, lethargy, and fever. A diagnosis of encephalitis is made after examination of spinal fluid. Which of the following clinical features suggests that the pathogen is West Nile virus?
A. Headache B. Confusion C. Monoparesis D. Target rash E. Visual hallucinations
500
A 15-year-old child has history of seizures beginning at the age of 9 years, followed by prolonged motor or sensory deficits lasting days to weeks. The pattern of the seizures and the focal deficits has changed over time. The patient also has hemicranial headaches. There is no family history of similar symptoms. Which of the following is the most likely diagnosis?
A. Adrenal leukodystrophy B. Subacute nectrotizing encephalomyelopathy C. Progressive Multifocal leukoencephalopathy D. Myoclonic epilepsy with ragged red fibers myopathy E. Mitochondrial enecephalomyopathy, lactic acidosis and stroke
500
Which of the following is generally believed to be the etiologic agent involved in fatal familial insomnia?
a. Bacteria b. Virus c. Chemical d. Fungus e. Prion
500
Characteristic lesions seen in the CT scans of patients who have had coma associated with carbon monoxide poisioning are located in which of the following areas of the brain?
a) Hypothalamus b) Globus pallidus c) Dentate nucleus d) Corpus callosum e) Cingulate Gyrus
500
A 71-year-old nursing home resident experiences symptoms including Parkinsonian gait disturbance, prominent delusions, fluctuation in level of attention, visual hallucinations, and sensitivity to the extrapyramidal effects of antipsychotic medications. This clinical presentation is most consistent with which of the following diagnoses?
A. Frontal dementia B. Vascular dementia C. Dementia with Lewy bodies D. Normal pressure hydrocephalus E. Alzheimer disease
500
A 65-year-old patient has fallen several times over the past 6 months. The patient’s mental status exam is normal. Smooth pursuit and saccadic movements are impaired, more prominently for vertical gaze, but full range of motion is easily elicited by doll’s head maneuvers. The patient has mild symmetric rigidity and bradykinesia. There is no tremor. A brain MRI scan is unremarkable as are the results of CSF and routine labs including toxic drug screens. Which of the following is most likely patient's diagnosis?
A. Corticobasal degeneration B. Olivopontocereballar degeneration C. Idiopathic Parkinson disease D. Primary progressive aphasia E. Progressive supranuclear palsy