NMS Q&A Family Medicine

74 NMS Q&A Family Medicine(A) Right brachial plexus(B) Right cerebellum(C) Left motor cortex(D) Left cerebellum(E) Left basal ganglia5 A 16-year-old boy has developed a movement disorder.When he abducts his arms, they begin to flap likebeating wings. Which of the following disease processesis likely to be the cause?(A) Hemochromatosis(B) Drug-induced tremor(C) Amyotrophic lateral sclerosis (ALS)(D) Wilson disease(E) Essential tremor6 A 67-year-old man has had a gradual onset of a resttremor over the past 2 years. On examination younote a 4- to 6-Hz flexion–extension tremor at theelbow and pronation–supination movement of theforearm. This patient may manifest each of the followingadditional findings except for which one?(A) Tremor worsens with stress.(B) Tremor diminishes with volition of themovement.(C) Tremor improves with alcohol ingestion.(D) Patient exhibits bradykinesia (slow, shufflinggait and decreased arm swinging).(E) Patient exhibits cogwheel rigidity.7 A 68-year-old white woman has been a patient ofyours for 2 years and is a lively conversationalist. Shehas had unexpected falls recently and complains of“weakness” of her legs. As she enters the office for thefirst time in 3 months, she manifests a wide-basedgait that you have not noted in the past. She complainsalso of urinary urgency incontinence. Sheanswers questions correctly but often takes long tospeak and is not as spontaneous in her responses asshe had been in the past. She can carry out sequentialtasks upon request. Which of the following conditionsexplains these findings?(A) Subdural hematoma(B) Multiple-infarct dementia(C) Multiple sclerosis (MS)(D) Normal pressure hydrocephalus (NPH)(E) Alzheimer disease (AD)8 Regarding the patient in Question 7, which of the followingis the mainstay of therapy?(A) Ventriculoperitoneal shunt(B) Glucocorticoid therapy(C) Nonsteroidal anti-inflammatory drug therapy(D) Physical therapy(E) Aspirin 85 mg daily9 A 25-year-old white female patient of German andDanish descent had an episode 3 months ago consistingof several days of urinary hesitancy, blurred visionin the left eye, and some difficulty in sureness of gait.She was visiting away and waited for her family’sreturn so as to be able to consult you, her primaryphysician. However, by the time she had returnedfrom vacation, the symptoms had disappeared. Now,these symptoms are recurring in a slightly differentform. She now complains of diplopia, hypesthesias,paresthesias, and an electrical sensation down thespine when she flexes her neck. Her gait is again disturbed,and she manifests hyperreflexia on the leftlower extremity along with a Babinski sign. Which ofthe following is the most sensitive test for diagnosingher condition?(A) Computed tomography scan of the head(B) Lumbar puncture(C) Serologic test for Lyme disease(D) Test for vitamin B 12 blood level(E) Magnetic resonance image (MRI) of the brain10 Regarding the patient in Question 9, each of the followingis an approved disease-modifying drug for thecondition except for which one?(A) Interferon 1a(B) Interferon 1b(C) Glatiramer(D) Infliximab(E) Mitoxantrone11 A 78-year-old woman is brought by her family forgradual loss of the ability to care for herself. Althoughshe is fully ambulatory and her level of consciousnessis full, she has left her kitchen stove on without knowingit and has lost total control of her checkbook,whereas in the past she had been assiduous in themanagement of her financial affairs. The family physiciandiagnoses dementia. Which of the followinglists of ancillary studies would be the most propitiousfor diagnosing reversible causes of her dementia?(A) Complete blood count, thyroid-stimulatinghormone, noncontrast computed tomographyscan of the head, mental status examination(B) Serum electrolytes, liver function battery(C) Chest x-ray, upper endoscopy(D) Liver biopsy and serum iron, total iron-bindingcapacity, and ferritin levels(E) Carotid angiogram12 A 67-year-old man is brought to you by his familybecause of rigid gait and lack of facial expressioncoming on over a period of several months. You suspectParkinson’s disease (PD). Many aspects of PD