FOLLOWYOURHEART

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Hey it would be great if anyone could help out with these questions.
Please mention your correct answer with explanation.
Thanks.

1.A 67-year-old man is brought to the physician by his wife because of a 6-month history of difficulty remembering both recent and remote events. He also has had jerky movements of his arms and legs for 4 weeks. He has had loss of balance and has fallen several times while walking. He is inattentive. Examination shows frequent myoclonic jerking of all extremities, increased muscle tone, and hyperactive reflexes. Babinski sign is present bilaterally. A CT scan of the head shows mild atrophy. Cerebrospinal fluid analysis shows no abnormalities except for a protein concentration of 80 mg/dL. EEG shows a generalized slow background interrupted by synchronous sharp wave complexes. Which of the following is the most likely diagnosis?

A) Creutzfeldt-Jakob disease

B) Dementia, Alzheimer type

C) Dementia with Lewy bodies

D) Hepatolenticular degeneration (Wilson disease)

E)Multi-infarct (vascular) dementia

2. An 18-year-old man comes to the physician because of difficulty walking for 1 week. Examination shows visual fields that are constricted equally in both eyes on close and distant testing. He has collapsing effort on muscle strength testing in the left extremities. He staggers from side to side when walking but does not fall. On Romberg testing, he abruptly falls to the left. There is hemisensory loss to light touch, pinprick, vibration, and proprioception on the left that stops exactly at the midline. Which of the following is the most likely diagnosis?

A) Cerebellar degeneration

B) Cervical spinal cord compression

C) Conversion disorder

D) Guillain-Barré syndrome

E) Multiple sclerosis

F) Sensory neuropathy

G) Tabes dorsalis

H) Vitamin B12 (cobalamin) deficiency

3. Over the past 2 years, a 35-year-old woman has had episodes of a spinning sensation. The episodes occur abruptly, are associated with nausea and vomiting, and last about 1 hour. The first episode occurred when the airplane in which she was traveling ascended to cruising altitude. Subsequent episodes have occurred on elevators, and she has had mild episodes when she sneezes. Two years ago, she sustained a concussion after a fall. Examination shows decreased hearing in the right ear

A) Acoustic schwannoma

B) Benign positional vertigo

C) Cerebellar hemorrhage

D) Complex partial seizure

E) Endolymphatic fistula

F) Hyperventilation syndrome

G) Meniere disease

H) Postural hypotension

I) Vertebrobasilar transient ischemic attack

4. A 25-year-old woman has had daily frontal headaches for 2 months. The pain generally begins as a dull ache soon after waking and gradually worsens. The pain is exacerbated by loud noise or stress and relieved by acetaminophen and sleep. Physical examination shows no abnormalities. Which of the following is the most likely diagnosis?

A) Cerebral neoplasm

B) Cluster headache

C) Frontal sinusitis

D) Migraine with aura

E) Migraine without aura

F) Temporal arteritis

G) Tension-type headache

H) Trigeminal neuralgia

5. Five weeks after being discharged from the hospital after treatment for a psychotic episode, a 27-year-old man comes to the physician for a follow-up examination. During hospitalization, he claimed that he was instructed by the Lord to found a new religion and that a famous gospel singer was in love with him. Today, he says that he still hears the voices of the Lord and members of the church he attends in his apartment and when he shops in the supermarket. He no longer believes the world needs a new religion because the Lord is no longer instructing him to create one. He states, "My father in heaven tells me that he is at peace, and therefore, so am I." Current medications include risperidone and lorazepam. He drinks one to two beers on weekends. He used marijuana regularly in college but has abstained for the past 5 years. He appears clean and is casually dressed. His temperature is 36.7°C (98°F), pulse is 72/min, respirations are 20/min, and blood pressure is 130/72 mm Hg. Physical examination shows no abnormalities. Mental status examination shows a calm affect. He is cooperative, alert, and oriented to person, place, and time. Based on this information, which of the following is the most likely current diagnosis for this patient?

A) Bipolar disorder

B) Cyclothymic disorder

C) Delusional disorder

D) Schizoaffective disorder

E) Substance-induced mood disorder

6. A 27-year-old man is brought to the emergency department 30 minutes after his brother found him agitated, tremulous, and complaining of a headache. He had eaten a peanut butter sandwich 12 hours before his symptoms began. He has a 10-year history of severe major depressive disorder. During this period, he has attempted suicide three times despite treatment with both selective serotonin reuptake inhibitors and tricyclic antidepressants. Eight days ago, he went to a new physician because of increasing despondency. This physician immediately discontinued the fluoxetine and substituted tranylcypromine to start 1 week later. He also instructed the patient to start a monoamine oxidase inhibitor diet immediately. Current medications also include diphenhydramine as needed for seasonal allergies. He has no history of hypertension, diabetes mellitus, or migraine. On arrival, he is agitated. His temperature is 40.6°C (105°F), pulse is 130/min, respirations are 26/min, and blood pressure is 180/120 mm Hg. Physical examination shows diaphoresis and tremor of the upper extremities. Deep tendon reflexes are 3+ bilaterally; there are no pathologic reflexes. On mental status examination, he is complaining of occipital headache. He is oriented to person but not to place or time. Which of the following is the most likely cause of these findings?

A) Acute anxiety attack

B) Acute fluoxetine withdrawal

C) Drug-drug interaction

D) Ingestion of peanut butter

E) Use of diphenhydramine

7. A 57-year-old woman comes to the physician because of difficulty sleeping, tearfulness, and restlessness since her daughter was diagnosed with metastatic breast cancer 3 days ago. She reports that when she goes to bed at night, she is unable to fall asleep for several hours and lays in bed worrying about her daughter's situation. The patient underwent a mastectomy for breast cancer 7 years ago. She takes acetaminophen/butalbital for occasional migraines. Her vital signs are within normal limits. Physical examination shows no abnormalities. On mental status examination, she is tearful and tense but calms during the conversation. There is no evidence of suicidal ideation. Which of the following is the most appropriate next step in management?

A) Biofeedback

B) Carbamazepine therapy

C) Clonazepam therapy

D) Clonidine therapy

E) Imipramine therapy

F) Olanzapine therapy

G) Pentobarbital therapy

H) Sertraline therapy

8. A 47-year-old woman is brought to the emergency department by her husband because of increasing confusion during the past 2 days. On arrival, she has a generalized tonic-clonic seizure lasting 4 minutes. She has bipolar disorder treated with several medications, but her husband is unsure of their names. He knows that she sometimes takes ibuprofen for mild arthritis pain caused by exercise. He says that she has been active and exercising more lately, but he cannot think of other changes in her routine. She has no history of seizure disorder. She is oriented to person but not to place and time. Her pulse is 90/min, and blood pressure is 140/90 mm Hg. On physical examination, she is tremulous and somnolent. There is bilateral nystagmus. An ECG shows a second-degree atrioventricular block. The most likely cause of this patient's symptoms is an adverse effect of which of the following medications?

A) Bupropion

B) Haloperidol

C) Lithium

D) Risperidone

E) Valproic acid

9. A 27-year-old woman comes to the physician for an examination prior to starting a new job. She has a 10-year history of binge-eating and self-induced vomiting. She takes no medications. She does not drink alcohol or use illicit drugs. She is 178 cm (5 ft 10 in) tall and weighs 72 kg (160 lb); BMI is 23 kg/m2. Her temperature is 37°C (98.6°F), pulse is 70/min, respirations are 10/min, and blood pressure is 120/70 mm Hg. Physical examination shows yellow dental enamel and abdominal striae. Serum studies are most likely to show which of the following abnormalities?

A) Decreased bicarbonate concentration

B) Increased amylase activity

C) Increased magnesium concentration

D) Increased potassium concentration

E) Increased sodium concentration

10. A 32-year-old woman comes to the physician because of increasingly severe pain that originates in her left shoulder and radiates to her elbow. She describes the pain as constant and burning, rating her current pain as a 7 on a 10-point scale. Eighteen months ago, she sustained a nerve injury of the left upper extremity in a motor vehicle collision. Since that time, she has been unable to return to work. Current medications include oxycodone and gabapentin. Physical examination shows atrophy of the left thenar eminence. Muscle strength in the left forearm and finger flexors is 3/5. On sensory examination, there is severe pain with light stroking of the anterolateral aspect of the left arm. Further sensory testing is deferred. During the examination she tells her physician, "I'm tired of all this. My medication is not strong enough. It only takes the edge off my pain, which is only getting worse. I'm realizing I'll be like this forever." Which of the following is the most appropriate response by the physician?

A) "Are you worried about more nerve damage developing?"

B) "Do you ever use more pain medication than is prescribed?"

C) "Have you been feeling like just giving up?"

D) "Is the pain caused by touch socially limiting?"

E) "Let's review your medical concerns."

11. An 18-year-old man is brought to the emergency department by friends 1 hour after they found him on the couch at a party unable to move. Earlier that evening, he had been using synthetic heroin. On arrival, his pulse is 85/min, respirations are 18/min, and blood pressure is 130/80 mm Hg. Examination shows stiffness in all extremities, drooling, and slow response to questions. Which of the following brain regions is most likely affected?

A) Cerebellar vermis

B) Globus pallidus

C) Locus ceruleus

D) Mammillary bodies

E) Nucleus accumbens

F) Substantia nigra

12. A 2-year-old girl is brought to the physician because of a 2-week history of irritability, poor appetite, occasional cough, and reluctance to walk. She has had a 2-kg (4.4-lb) weight loss since her last examination 6 months ago. There is no history of recurrent respiratory illness, constipation, vomiting, or diarrhea. She appears uncomfortable and quiet. She is at the 75th percentile for height and 25th percentile for weight. Her temperature is 37.9°C (100.2°F), pulse is 140/min, respirations are 24/min, and blood pressure is 145/100 mm Hg. Examination shows bluish discoloration under both eyelids. Cardiac and abdominal examinations show no abnormalities. Laboratory studies show:

Hemoglobin 10.5 g/dL
Leukocyte count 8300/mm3
Segmented neutrophils 40%
Eosinophils 2%
Lymphocytes 55%
Monocytes 3%
Platelet count 240,000/mm3

A lateral x-ray of the chest shows a mass in the posterior mediastinum. Which of the following is the most likely diagnosis?

A) Anthrax exposure

B) Congenital heart disease

C) Cystic fibrosis

D) Dermatomyositis

E) Neuroblastoma

F) Pulmonary sequestration

G) Thymoma

H) Tuberculosis

13. A previously healthy 3-year-old girl is brought to the physician because of a 2-month history of a right-sided limp. The limp is most obvious when she awakens and gradually becomes less noticeable as she plays. She has no recent history of fever, rash, or other illness and has not been exposed to pets or ticks. Today, she appears well but walks with a limp. Her temperature is 36.8°C (98.2°F). Examination of the skin shows no rash. The pupils are equal, round, and reactive to light and accommodation. Red reflex is normal bilaterally. The pharynx is pink, and the mucosa is moist. Cardiac examination shows a regular rate and rhythm and no murmurs. S1 and S2 are normal. The right knee is swollen and warm but not erythematous or tender. The patient holds the right lower extremity in a slightly flexed position and will not fully extend it when she stands or walks. Laboratory studies show:

Erythrocyte sedimentation rate 64 mm/h
Serum
Antinuclear antibody positive
Rheumatoid factor negative
Antistreptolysin O titer negative
Lyme (Borrelia burgdorferi) antibody negative

In addition to administration of naproxen, which of the following is the most appropriate next step in management?

A) Slit-lamp examination

B) Bartonella henselae titer

C) Upper gastrointestinal series

D) Arthroscopy

E) Surgical aspiration of the right knee

14. A 15-month-old girl is brought to the physician because of a 1-day history of rash. She has had fever for the past 3 days. She received a measles-mumps-rubella vaccine 10 days ago. She is not in acute distress. Her temperature is 38.4°C (101.2°F). Examination shows an erythematous maculopapular rash over the face, trunk, and extremities. Which of the following is the most likely explanation for these findings?

A) Arthus reaction from preexisting antibody to rubella virus

B) Delayed-type hypersensitivity reaction to rubella antigen

C) Immune complex disease from vaccine preservatives

D) Replication of a live vaccine virus strain

E) Viral dissemination in an immunocompromised host
 
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D1stant

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C) Lithium, causes seizurs, heart block and nystagmus, the others don't

Second snswer is also C... MAOI interacts with Diphenhydramine
 
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