Property:Prompt
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A 20 year old high school football player is brought to emergency room with the complaint of passing blood in his urine. He developed this complaint three hours after his football match when he got kicked in his left flank. Physical examination does not reveal any significant finding. His vital signs are heart rate 70 beats/min, respiratory rate 16/minute, blood pressure 110/70 mm Hg and oral temperature 36.8 C. The initial diagnostic tests in the emergency room should include which of the following? +
A 20 year old high school football player is brought to emergency room with the complaint of passing blood in his urine. He developed this complaint three hours after his football match when he got kicked in his left flank. Physical examination does not reveal any significant finding. His vital signs are heart rate 70 beats/min, respiratory rate 16/minute, blood pressure 110/70 mm Hg and oral temperature 36.8 C. Along with the initial diagnostic tests in the emergency room, an intravenous pyelography was done for a suspected genitourinary tract injury. The diagnostic test performed, revealed an extravasation of contrast into the renal parenchyma. Treatment of this patient should consist of +
A 27-year-old man presents to the physician's office for persistent watery diarrhea of 2 weeks duration, abdominal pain, and recent unintentional weight loss. Physical examination is remarkable for skin pallor and diffuse abdominal tenderness. Following appropriate work-up, the patient undergoes GI endoscopy that demonstrates transmural granulomatous inflammation with cobblestone mucosa and skip lesions in the small intestine. Which of the following additional findings is most likely present in this patient? +
A 25-year-old man presents to the physician's office with complaints of bloody diarrhea and abdominal pain for the past 2 weeks. The patient explains that he consumes a high-fat, low-starch diet and has a sedentary lifestyle. Initial work-up reveals loss of haustra on abdominal x-ray. Endoscopy shows formation of pseudopolyps, and biopsies of the GI tract show mucosal and submucosal inflammation in the colon that involve the rectum. Which of the following factors plays a protective role against the patient's condition? +
A previously healthy 14-year-old boy is brought by his mother for a two-day history of muscle weakness in the lower extremities. The mother reports that her child had a prodrome of fever, headaches, and vomiting for a few days. The mother informs the physician that the family has recently emigrated from Nigeria less than a month ago. Neurological examination reveals muscle weakness in the lower extremities more pronounced on the right side, absent reflexes in the legs bilaterally and muscle fasciculations in both femoral regions. Sensory neurological exam is unremarkable in the upper and lower extremities. A lumbar puncture is performed, and CSF profile demonstrates leukocytosis. A neurological lesion in the spinal cord is suspected. Which of the following spinal cord images (lesions depicted in red) represents the site of the neurological lesion in this child? +
A 22-year-old woman presents to her primary care physician for acute right arm weakness. The patient woke up this morning and felt that her right arm is heavy, and she could not lift it. She does not recall any history of trauma to her arm or similar previous episodes. Upon further questioning, the patient's past medical history is significant for one episode of acute vision loss in her right eye that resolved spontaneously almost one year ago. Neurological examination reveals decreased sensation and motor strength in the right upper extremity, in addition to loss of vibratory sensation in the left lower extremity. Which of the following images of the spinal cord represents the site of the lesion of the patient (lesion in red)? +
A 35-year-old man presents with a one-month history of progressive weakness in his upper extremities. The patient initially had difficulty moving his right arm but was then complaining of inability to move both arms. He also reports stuttered speech and some occasional twitching in his arms. The patient works as a lawyer and has been lately frustrated because of his symptoms. Physical examination of the upper extremities reveals bilateral fasciculation, proximal muscle atrophy, and weakness that is more pronounced in the right upper extremity than in the left. Rigidity is noted upon attempting to passively extend the patient’s arms. Sensory neurological examination is unremarkable in both upper and lower extremities. Babinski sign is positive bilaterally. Based on the clinical history and physical examination findings, which of the following images correlates with the site of the neurological lesion in the patient (lesion in red)? +
A 68-year-old left-handed man with a past medical history of chronic stable angina and hypertension presents to the emergency department with violent involuntary movements of his right extremities for the past 3 hours. The patient explains that these attacks began suddenly and have since been repetitive and uncontrollable. Physical examination is remarkable for non-rhythmic, continuous, violent flinging motions of the right upper and lower extremities. Although a cranial CT scan is negative, an underlying small ischemic stroke is still suspected. Which of the following receptors is a significant component of the pathway involved in this patient's condition? +
A 66-year-old woman, who had a recent hip fracture after a fall, presents to the neurology clinic with complaints of hand tremor for the past few months. Although the tremor has not significantly worsened over time, the patient explains that it is very bothersome and interferes with her daily activities. The patient notices the tremor only when she performs activities that require use of her arms. On physical examination, the physician notes an absence of a baseline tremor; but when the patient is asked to reach for a pen, she exhibits a slow, coarse, zigzag motion of her hand as she extends for it. The tremor increases in intensity as the patient’s hand gets closer to the object. Also, the patient often overshoots and often requires a few attempts before grabbing the pen. What is the most likely cause of this patient's tremor? +
A 36-year-old woman presents to the neurology clinic with a complaint of a 1 week history of bilateral upper extremity weakness. Upon further questioning, the patient reports that for the past 3 months, she has had multiple burns in both hands because she cannot seem to distinguish hot objects. She also reports she has numbness over the shoulders and the arms that follow a cape-like pattern. Physical examination is remarkable for burn marks in both hands, loss of pain and temperature sensation in the shoulders and arms, and diminished upper extremity reflexes bilaterally. Which of the following images depicts the most likely location of the patient's lesion (lesion in red)? +
A 55-year-old woman with poor medical follow-up presents with ulcers on the soles of her feet. Upon questioning, the patient reports lower extremity numbness and imbalance for the past 3 months. She also complains of occasional urinary incontinence and shooting pains in her abdomen and back, which she sometimes attributed to indigestion. On physical examination, the physician notices bilateral miotic pupils that are non-reactive to light but are reactive to accomodation. He also notes the presence of foot ulcers, diminished reflexes in the lower extremities, and a wide-based, slapping gait. Which of the following images depict the spinal cord lesions that are most likely responsible for the patient's condition (lesion in red)? +
A 72-year-old man with a history of atrial fibrillation on warfarin is admitted to the hospital for progressively increasing headaches and speech dysfunction for the past 10 days. The patient's wife informs the physician that the patient complained of a headache that started insidiously almost 10 days ago following a head trauma and has been progressively getting worse. Upon questioning the patient, he answers back fluently and says: "A plane drink and I can not shower for coffee feet the trash". CT scan of the brain reveals a subdural hematoma. Which of the following brain regions is most likely responsible for the patient's speech dysfunction? +
A 71-year-old right-handed man with a past medical history significant for coronary artery disease and hypertension presents to the emergency department for acute-onset right arm weakness and speech difficulty. The patient is not able to speak in full sentences and answers by saying: "Ummm...Ummm..Not move..Ummm arrr...arm". Whenever the physician asks him a question, the patient tries to answer by using hand gestures. Which of the following brain regions is most likely responsible for the patient's speech dysfunction? +
A 65-year-old woman is being evaluated for speech dysfunction in the stroke unit. During history taking, she is able to initiate speech and respond fluently in full meaningful sentences. Also, she succeeds in naming objects that the physician points to. During the assessment, the physician asks the patient to repeat the sentence: "No ifs ands or buts"; however, the patient is unable to do so. Which area in the brain is most likely affected by the stroke and is responsible for this patient's speech dysfunction? +
Experimental studies suggest that age-related dementia may be caused by chronic cerebral ischemia that results from decreased cerebral perfusion. A new investigational drug is being evaluated for its possible role in the prevention of dementia. Cerebral perfusion studies during non-stressful events are performed following the administration of the investigational drug. Studies reveal vasodilation of the cerebral arteries. The vasodilation observed following the administration of the drug is similar to that of which of the following physiological mechanism? +
A 32-year-old woman presents to the gynecology clinic for 3 months of absent menstruation. The patient has been trying to get pregnant for the past year but has been unsuccessful. She reports decreased libido and episodes of bilateral milky breast discharge. She also explains that she has been having difficulty driving and has failed a road test twice. Which of the following visual field patterns is most likely present in this patient? +
A 60 year-old-man presents to the neurology clinic for 2 months of left-sided throbbing headache. The man has no significant past medical history except for hypertension. He describes a constant retro-orbital headache non-responsive to regular analgesic therapy. He did not make much of the headache until recently when he noticed changes in his visual field which prompted him to seek medical care. His neurologist orders a brain MRI that shows a large left internal carotid artery aneurysm at the origin of the ophthalmic artery. Which of the following visual field defects would you expect in this patient? +
A 35-year-old woman has lived alone most of her adult life. She has no friends and does not like leaving the house much. She has never had an intimate relationship and prefers being alone. She spends her days drawing and collecting random objects which she fashions into dolls. What is the most likely personality disorder present in this patient? +
A 42 year-old-woman has had 7 relationships in the past year all of which she claims were the most intense loves of her life. She has written many songs about her relationships and has sworn she would kill herself if any of her previous lovers tried to leave her. She has also had 2 episodes of major depression in the past year and was arrested for assaulting one of her friends after they had a minor argument. Which of the following types of defense mechanisms is most likely to be present in this patient? +
Deep brain stimulation (DBS) is an invasive therapeutic procedure indicated for advanced Parkinson's disease. It consists of the surgical implantation of a device that sends high frequency electrical impulses into areas of the basal ganglia, particularly the subthalamic nucleus (STN) and the globus pallidus internus (GPi). It is hypothesized that the mechanism by which DBS improves parkinsonism symptoms includes hyperpolarization in the STN by DBS, which results in a reduction in the subthalamic excitability. Which of the following changes in neurotransmitter release is the result of the reduction in subthalamic excitability? +