All are true about Creutzfeldt-Jakob Disease, except:It is a neurodegenerative disease caused by prions
Accumulation in the brain of a normal protease-resistant prion protein
An elevated level of 14-3-3 protein in CSF
It is subacute dementia with rapid clinical progression
B
What is true about Huntington Disease?:
Life expectancy is 20 years from the time of diagnosis
Multiple abnormal CAG triplet repeats on chromosome 5
Anticipation is related to less severe disease
Multi9ple abnormal GAA triplet repeats on chromosome 9
A
Patient with Parkinson's Disease, his primary symptom is tremor. Which is the best medication?:
Amantadine
Benztropine
Selegiline
Entacapone
A
Mechanism of action of amantadine?:
A weak non-competitive NMDA receptor antagonist
It blocks the peripheral conversion of levodopa
Anticholinergic
MAO-B inhibitor
A
Mechanism of action of ropinirole and bromocriptine?:
MAO-B inhibitor
COMT inhibitor
Dopamine agonist
Anticholinergic
C
Mechanism of action of Selegiline?:
Anticholinergic
COMT inhibitor
Dopamine agonist
MAO-B inhibitor
D
Mechanism of action of Entacapone and tolcapone?:
Anticholinergic
COMT inhibitor
Dopamine agonist
MAO-B inhibitor
B
Mechanism of action of Benztropine and trihexyphenidyl?:
Anticholinergic
COMT inhibitor
Dopamine agonist
MAO-B inhibitor
A
What is the most often primary cancer in metastatic brain tumors?:
Breast cancer
GI tract cancer
Melanoma
Lung cancer
D
Symptoms of increased intracranial pressure?:
Nausea, vomiting, headache, and confusion
Nausea, vomiting, headache, and diplopia
Fever, weight loss, and headache
Headache, fever, and nuchal rigidity
B
Diagnostic criteria for Neurofibromatosis 1, except:
Café-au-lait spots
Optic glioma
Lisch nodules
Bilateral vestibular schwannomas
D
Patient with a history of Meningioma and neurofibroma. What is the diagnosis?:
Neurofibromatosis 1
Neurofibromatosis 2
Tuberous Sclerosis
Sturge-Weber disease
B
What structures are included in the limbic system?:
Caudate, putamen, globus pallidus, substantia nigra, and subthalamic nucleus
Habenula, habenular commissure, posterior commissure, and the pineal gland
Subthalamic nucleus, red nucleus, and substantia nigra
Amygdala, hippocampus, fornix, mammillary bodies, cingulate gyrus, and parahippocampal gyrus
D
What structures are included in Basal ganglia?:
Caudate, putamen, globus pallidus, substantia nigra, and subthalamic nucleus
Habenula, habenular commissure, posterior commissure, and the pineal gland
Subthalamic nucleus, red nucleus, and substantia nigra
Amygdala, hippocampus, fornix, mammillary bodies, cingulate gyrus, and parahippocampal gyrus
A
What structures are included in the Epithalamus?:
Caudate, putamen, globus pallidus, substantia nigra, and subthalamic nucleus
Habenula, habenular commissure, posterior commissure, and the pineal gland
Subthalamic nucleus, red nucleus, and substantia nigra
Amygdala, hippocampus, fornix, mammillary bodies, cingulate gyrus, and parahippocampal gyrus
B
What structures are included in the Subthalamus?:
Caudate, putamen, globus pallidus, substantia nigra, and subthalamic nucleus
Habenula, habenular commissure, posterior commissure, and the pineal gland
Subthalamic nucleus, red nucleus, and substantia nigra
Amygdala, hippocampus, fornix, mammillary bodies, cingulate gyrus, and parahippocampal gyrus
C
Pathway in Papez circuit?:
Fornix hippocampus mammillary bodies mammillothalamic tract anterior nucleus of the thalamus thalamocingulate radiation cingulate gyrus hippocampus
Hippocampus mammillary bodies fornix mammillothalamic tract anterior nucleus of the thalamus thalamocingulate radiation cingulate gyrus hippocampus
Hippocampus fornix mammillary bodies mammillothalamic tract anterior nucleus of the thalamus thalamocingulate radiation cingulate gyrus hippocampus
Hippocampus fornix mammillary bodies mammillothalamic tract anterior nucleus of the thalamus cingulate gyrus thalamocingulate radiation hippocampus
C
What is the function of the ventromedial nucleus?:
Satiety
Hunger
Heat dissipating
Heat conservation
A
What is the function of the anterior hypothalamus?:
Satiety
Hunger
Heat dissipating
Heat conservation
C
What is the function of the posterior hypothalamus?:
Satiety
Hunger
Heat dissipating
Heat conservation
D
What is the function of the lateral area of the hypothalamus?:
Satiety
Hunger
Heat dissipating
Heat conservation
B
What is the function of suprachiasmatic nuclei?:
Heat conservation
Heat dissipating
Circadian rhythms
Synthesis of vasopressin and oxytocin
C
What is the function of supraoptic and paraventricular nuclei?:
Heat conservation
Heat dissipating
Circadian rhythms
Synthesis of vasopressin and oxytocin
D
The classic triad of Wernicke encephalopathy?:
Encephalopathy, ophthalmoplegia, and ataxia
Encephalopathy, ophthalmoplegia, and anterograde amnesia
Encephalopathy, ophthalmoplegia, and retrograde amnesia
Encephalopathy, horizontal nystagmus, and confabulations
A
Signs and symptoms of Korsakoff dementia?:
Encephalopathy, ophthalmoplegia, and ataxia
Encephalopathy, ophthalmoplegia, ataxia, amnesia, and confabulations
Encephalopathy, ophthalmoplegia, ataxia, and tremor
Encephalopathy, ophthalmoplegia, ataxia, and paraplegia
B
Which vitamin deficiency causes Wernicke encephalopathy?:
Vitamin B12
Vitamin B9
Vitamin B3
Vitamin B1
D
Which vitamin deficiency causes peripheral neuropathy?:
Vitamin B12
Vitamin B9
Vitamin B3
Vitamin B1
A
What is the etiology of Closed-Angle Glaucoma?:
Obstruction of drainage pathways by the iris
Decreased drainage due to damaged trabecular meshwork
Macular degeneration
Retinal vascular occlusion
A
What is the etiology of Open-Angle Glaucoma?:
Obstruction of drainage pathways by the iris
Decreased drainage due to damaged trabecular meshwork
Macular degeneration
Retinal vascular occlusion
B
Treatment for Open-Angle Glaucoma?:
Isoproterenol
Timolol
Furosemide
Atropine
B
The lesion in the left optic nerve and defect in the visual field?:
Right anopia
Right homonymous hemianopsia
Left homonymous hemianopsia
Left anopia
D
The lesion in the optic chiasm and defect in visual field?:
Central scotoma
Left hemianopia with macular sparing
Bitemporal hemianopsia
Right homonymous hemianopsia
C
The lesion in the right optic tract and defect in visual field?:
Right homonymous hemianopsia
Left homonymous hemianopsia
Left lower quadrantic anopsia
Right lower quadrantic anopsia
B
The lesion in left dorsal optic radiation?:
Right lower quadrantic anopsia
Left lower quadrant anopsia
Right upper quadrantic anopsia
Left upper quadrantic anopsia
A
The lesion in right Meyer Loop and defect in the visual field?:
Right lower quadrantic anopsia
Left lower quadrant anopsia
Right upper quadrantic anopsia
Left upper quadrantic anopsia
D
Left PCA infarction and defect in the visual field?:
Left hemianopsia with macular sparing
Right hemianopsia with macular sparing
left lower quadrantic anopsia
right lower quadrantic anopsia
B
Macular degeneration and defect in visual field?:
Hemianopsia with macular sparing
Upper quadrantic anopsia
Lower quadrantic anopsia
Central scotoma
D
What is true about central retinal artery occlusion?:
Swollen optic disc with hemorrhages
Retinal hemorrhages
Cotton-wool spots
Cherry-red spot of the fovea
D
What is true about central retinal vein occlusion?:
Retinal swelling
Bloodless retinal arteries
Cotton-wool spots
Cherry-red spot
C
HEMATOLOGY
Most common coagulation disorder in Ashkenazi Jews?:
Hemophilia A
Hemophilia B
Hemophilia C
Von Willebrand Disease
C
Mechanism of action of Heparin?:
Inhibits synthesis of vitamin K-dependent coagulation factors
Directly inhibit factor Xa
Inhibits factor II
Activates antithrombin
D
Mechanism of action of Warfarin?:
Inhibits synthesis of vitamin K-dependent coagulation factors
Directly inhibit factor Xa
Inhibits factor II
Activates antithrombin
A
Mechanism of action of Apixaban?:
Inhibits synthesis of vitamin K-dependent coagulation factors
Directly inhibit factor Xa
Inhibits factor II
Activates antithrombin
B
Mechanism of action of Dabigatran?:
Inhibits synthesis of vitamin K-dependent coagulation factors
Directly inhibit factor Xa
Inhibits factor II
Activates antithrombin
D
Mechanism of action of tPA?:
Inhibits synthesis of vitamin K-dependent coagulation factors
Directly inhibit factor Xa
Converts plasminogen into plasmin which breaks down fibrin
Activates antithrombin
C
The best initial test in the diagnosis of Hemophilia?
PTT
Mixing study
Specific factor assays
PT
B
Most accurate test in the diagnosis of Hemophilia?:
PTT
Mixing study
Specific factor assays
PT
C
What is the most common inherited bleeding disorder?:
Von Willebrand Disease
Hemophilia A
Bernard-Soulier syndrome
Glanzmann thrombasthenia
A
What is the most common cause of hereditary thromboembolic disease?:
Antithrombin III deficiency
Protein C deficiency
Factor V Leiden
Protein S deficiency
C
In which condition is seen decreased agglutination on the ristocetin cofactor assay?
Factor V Leiden
Von Willebrand disease
Bernard-Soullier syndrome
Glanzmann thrombasthenia
B
What is the condition caused by a deficiency in GpIIb/IIIa?:
Factor V Leiden
Von Willebrand disease
Bernard-Soullier syndrome
Glanzmann thrombasthenia
D
What is the condition caused by a deficiency in GpIb?:
Factor V Leiden
Von Willebrand disease
Bernard-Soullier syndrome
Glanzmann thrombasthenia
C
What is the mechanism of action of Clopidogrel and ticlopidine?:
Inhibits ADP receptor
Inhibits GpIIb/IIIa
Inhibits COX
Inhibits factor II
A
Lab findings in Von Willebrand disease?:
Increased bleeding time
Decreased PTT
Increased PT
Decreased platelet count
A
What is the cause of Idiopathic thrombocytopenic purpura?:
Deficiency of ADAMTS-13
IgG antibodies against patient’s platelets
Depletion of clotting factors and platelets
PF4 antibody
B
What is the cause of Thrombotic Thrombocytopenic Purpura?:
Deficiency of ADAMTS-13
IgG antibodies against patient’s platelets
Depletion of clotting factors and platelets
PF4 antibody
A
What is the cause of Heparin-induced Thrombocytopenia?:
Deficiency of ADAMTS-13
IgG antibodies against patient’s platelets
Depletion of clotting factors and platelets
PF4 antibody
D
What is the cause of tissue necrosis following warfarin administration?:
Vitamin C and S deficiency
Vitamin K deficiency
Activation of protein C
Activation of protein S
A
Clinical presentation and lab findings in TTP?:
Hemolytic anemia increased creatinine and low platelets without neurologic symptoms
Hemolytic anemia increased creatinine, low platelets, increased TP, increased bleeding time
Hemolytic anemia, increased creatinine, low platelets, seizure, and fever
Hemolytic anemia, increased creatinine, low platelets, retroperitoneal bleeding, and fever
C
Clinical presentation and lab findings in HUS?:
Hemolytic anemia increased creatinine, and low platelets without neurologic symptoms
Hemolytic anemia increased creatinine, low platelets, increased TP, increased bleeding time
Hemolytic anemia, increased creatinine, low platelets, seizure, and fever
Hemolytic anemia, increased creatinine, low platelets, retroperitoneal bleeding, and fever
A
Best initial abortive therapy for Migraine?:
Gabapentin
Triptans
NSAIDs
Dihydroergotamine
C
Prophylaxis for Migraine includes, except:
a) Propanolol
b) Amitriptyline
c) Triptans
d) Topiramate
C
Best initial abortive therapy for Cluster headaches?:
a) 100% O2
b) NSAIDs
c) Triptans
d) Acetaminophen
A
Best prophylactic therapy for Cluster headache?:
a) Valproate
b) Propanolol
c) Amitriptyline
d) Verapamil
D
A 34-year-old patient presents with severe, shooting pain, 6/10, on the right side of his face. It lasts less than one minute and presents several times during the day. He states the pain is worse after chewing or brushing his teeth. He denies fever, changes in his vision, lacrimation, rhinorrhea, nausea, or vomiting. What is the best explanation for his condition?:
a) Migraine
b) Trigeminal neuralgia
c) Cluster headache
d) Temporal arteritis
B
What is the first-line therapy for the condition of the previous patient?:
a) Verapamil
b) Valproate
c) Carbamazepine
d) Steroids
C
37-year-old female patient presents to ED for severe, constant, pressure-like headache (worst pain of my life), 10/10, that started suddenly this morning while she was exercising. The pain is getting worse, doesn’t alleviate with anything. It is associated with nausea, vomiting, photophobia. The physical exam is remarkable for the presence of the Brudzinski sign. What is the best initial step?:
a) Lumbar puncture and CSF analysis
b) CT scan of the head without contrast
c) CT scan of the head with contrast
d) MRI brain
B
First-line therapy in children with partial or tonic-clonic seizures?:
a) Levetiracetam
b) Phenytoin
c) Carbamazepine
d) Phenobarbital
D
First-line therapy for Absence seizures?:
a) Valproic acid
b) Levetiracetam
c) Ethosuximide
d) Carbamazepine
C
Which is the best initial therapy in status epilepticus?:
a) Midazolam
b) Phenytoin
c) Phenobarbital
d) Lorazepam
D
A patient is still in status epilepticus after 20 minutes besides the administration of benzodiazepines every 5 minutes, which is the best next step?:
a) Continue benzodiazepine for 20 more minutes
b) Start Phenytoin
c) Start Fosphenytoin
d) Start Phenobarbital
C
When is recommended continuous EEG monitoring?:
a) In convulsive status epilepticus
b) Patient does not wake up after clinically obviously seizures stop
c) During alcohol withdrawal
d) During benzodiazepines withdrawal
B
A 55-year-old patient presents in ED with sudden severe vertigo, nausea, vomiting, and difficulty standing up. He was diagnosed with URI 10 days ago. The physical exam is remarkable for vertical nystagmus and gait unsteadiness. He has a past history of Hypertension, DM T1, and CHF. What is the best initial step?:
a) Diffusion-weighted MRI
b) Start meclizine
c) Start steroids
d) Start NSAIDs
A
In the presentation of Benign Paroxysmal Positional Vertigo, which one is incorrect?:
a) Vertigo lasts < 1 min
b) It is not associated with hearing loss
c) Epley maneuver can resolve the symptoms
d) Meclizine is the best initial therapy
D
In Labyrinthitis, which of the following symptoms is incorrect?:
a) Lacking hearing loss
b) Tinnitus
c) Ear fullness
d) Nausea and vomiting
A
What is correct about Ménière's disease?:
a) Recurrent episodes of vertigo, tinnitus, nausea, vomiting, and hearing loss
b) Acute vertigo, nausea, vomiting, and hearing loss after a recent URI
c) Acute vertigo and nystagmus triggered by changes in head position
d) Acute vertigo, nausea, vomiting without hearing loss after a recent URI
A
What is correct about Vestibular neuritis?:
a) Recurrent episodes of vertigo, tinnitus, nausea, vomiting, and hearing loss
b) Acute vertigo, nausea, vomiting, and hearing loss after a recent URI
c) Acute vertigo and nystagmus triggered by changes in head position
d) Acute vertigo, nausea, vomiting without hearing loss after a recent URI
D
Lab findings in Iron Deficiency Anemia?:
High ferritin, high RDW, high TIBC, low serum iron
Low ferritin, low RDW, high TIBC, low serum iron
Low ferritin, high RDW, high TIBC, low serum iron
Low ferritin, low RDW, low TIBC, low serum iron
C
Lab findings in Anemia of Chronic Disease?:
High ferritin, low serum iron, normocytic anemia
Low ferritin, low serum iron, microcytic anemia
High ferritin, high serum iron, normocytic anemia
Low ferritin, high serum iron, normocytic anemia
A
Lab findings in Megaloblastic Anemia due to B12 deficiency?:
Macrocytic anemia increased MMA and increased homocysteine
Macrocytic anemia, normal MMA, and increased homocysteine
Macrocytic anemia, normal MM, and normal homocysteine
Macrocytic anemia, increased MMA, and normal homocysteine
A
Lab findings in Megaloblastic Anemia due to B9 deficiency?:
Macrocytic anemia increased MMA and increased homocysteine
Macrocytic anemia, normal MMA, and increased homocysteine
Macrocytic anemia, normal MM, and normal homocysteine
Macrocytic anemia, increased MMA, and normal homocysteine
B
What is the most common cause of osteomyelitis in patients with Sickle Cell Disease?:
S aureus
Salmonella
S epidermidis
Shigella
B
What is false about complications in Sickle Cell Disease?:
Splenic sequestration resulting in hypovolemia
Parvovirus B 19 infection resulting in aplastic crisis
Low platelets
Increased PTT
D
What is true about Warm Autoimmune Hemolytic Anemia?:
Presence of IgM antibodies
Presence of IgG antibodies
It is associated with Mycoplasma pneumonia
It is associated with Mononucleosis
B
What is true about Cold Autoimmune Hemolytic Anemia?:
Presence of IgG antibodies to RBC antigens
It is associated with Mycoplasma pneumonia
It is associated with Mononucleosis
It is associated with SLE
D
All are true about Hereditary spherocytosis, except?:
Presence of spherocyte
Positive osmotic fragility tests
Negative direct Coombs test
Positive direct Coombs test
D
What is not a cause of Aplastic Anemia?:
HIV infection
Parvovirus B 19 infection
Sulfa drugs
Ciprofloxacin
D
What is not true about Thalassemia?:
African, Middle Eastern, and Asian descent are mostly affected
Microcytic anemia with normal serum iron
Microcytic anemia with low serum iron
Most patients with Thalassemia do not require treatment
C
What is not present in hyperviscosity syndrome ?:
Easy bruising
Blurred vision
Pruritus after a cold bath
Thrombosis
C
What is the best initial test in the diagnosis of Polycythemia Vera?:
JAK 2 mutation
CBC
CBC with an ABG and EPO level
EPO levels
C
