chapter 4-5-6

Question 1

Which of the fallowing are typical clinical features or delirium?
1. Disorientation
2. Altered level of consciousness
3. Disturbed sleep-wake cycle
4. Acute change in mental status
Select: A - 1. 2. 3. B = 1. 3. C = 2. 4. D = 4 only. E – All

Answer 1

E

Question 2

Important risk factors for the development of delirium in elderly hospitalized patients
include which of the following?
1. Age
2. Visual loss
3. Pre-morbid dementia
4. Dehydration
Select: A = 1. 2. 3. B = 1, 3. C = 2. 4. D = 4 only. E = All

Answer 2

E

Question 3

Many prescription and over-the-counter medications have anticholinergic side effects.
These can produce problems in elderly patients especially when used in combination.
Signs of anticholinergic excess include all of the following except:
A. Hypothermia
B. Dry mouth
C. Confusion
D. Flushing
E. Mydriasis

Answer 3

A

Question 4

A patient is admitted to the hospital for cheM pain and is noted to be confused. The
following list of diagnoses are among those which should be considered. Each question
presents a small piece of additional clinical information. Select the diagnosis which is
most likely for each question.
A. Hospitalization-related confusion
B. Dementia
C. Aphasia
D. Depression
E. Schizophrenia

Patient presents with complaints of memory loss for the past two months, has a normal
examination except mental slowness and diffuse decrease in memory, affecting recent
more than remote memory.

Answer 4

B

Question 5

A patient is admitted to the hospital for cheM pain and is noted to be confused. The
following list of diagnoses are among those which should be considered. Each question
presents a small piece of additional clinical information. Select the diagnosis which is
most likely for each question.
A. Hospitalization-related confusion
B. Dementia
C. Aphasia
D. Depression
E. Schizophrenia

Patient presents with the inability to follow purely verbal commands yet can follow
visual cues well.

Answer 5

C

Question 6

A patient is admitted to the hospital for cheM pain and is noted to be confused. The
following list of diagnoses are among those which should be considered. Each question
presents a small piece of additional clinical information. Select the diagnosis which is
most likely for each question.
A. Hospitalization-related confusion
B. Dementia
C. Aphasia
D. Depression
E. Schizophrenia

Patient develops confusion and agitation at night while in the hospital, which resolves
during the day. Patient tends to be awake much of night and sleeps part of the day.
Patient sees bugs on the wall and reacts to visions of children outside the window.

Answer 6

A

Question 7

Disturbance of the sleep-wake cycle in patients with delirium can have which of the
following clinical manifestations?
1. Wandering at night
2. Sundown syndrome
3. Daytime drowsiness
4. Sleep attacks with REM-onset sleep
Select: A = 1, 2,3. B= 1, 3. C = 2,4. D = 4 only. E = All

Answer 7

A

Question 8

Delirium not only affects basic cognition and mood but also other cognitive functions,
although some functions can be relatively preserved. Which of the following abilities are
typically preserved in patients with delirium?
1. Writing
2. Visual object recognition
3. Drawing and constructions
4. Speaking
Select: A = 1, 2, 3. B = 1, 3. C = 2,4. D = 4 only. E = All

Answer 8

D

Question 9

Which of the following metabolic derangements should be considered in fhe differential
diagnosis of delirium?
1. Hyponatremia
2. Hypoglycemia
3. Hyperearbia
4. Hypoxia
Select: A = I, 2, 3. B = 1. 3. C = 2, 4. 0 = 4 only. E = All

Answer 9

E

Question 10

Which is the best way to handle the sleep disturbance of hospitalized patients with
delirium?
A. Frequent staff visits to check on the patient
B. Aggressive stimulation of the patient during the daytime
C. Nightly pbenobarbital to assist sleep and lessen agitation
D. Provide a familiar environment with calendar, family pictures, personal items
E. All of the above

Answer 10

D

Question 11

Which of the following statements is true regarding the prognosis of patients with
delirium during hospitalization?
1. Most show some recovery
2. Recovery is often incomplete
3. Pre-existing incipient dementia may be more evident following the
hospitaiization-associated delirium
4. Recovery to a baseline may take months
Select: A = 1,2., 3 B = I, 3. C = 2.4. D = 4 only. E = All

Answer 11

E

Question 12

Which of the following cerebrovascular disorders would be expected to be associated
with delirium?
1. Bilateral carotid stenosis
2. Right middle cerebral artery infarct
3. Thalamic stroke
4. Unruptured posterior communicating artery aneurysm
Select: A = 1,2,3. B= 1,3. C = 2,4. D = 4 only. E = All

Answer 12

A

Question 13

Persistent vegetative state is often the sequel of coma when patients have not improved to
norma! consciousness Which of the following features are expected in this state?
1. Preserved steep-wake cycles
2. Eyes open in response to stimulation
3. intact regulation of cardiac and respiratory function
4. Ability to respond commands only with eye blinks and vertical eye movements
Select- A = 1. 2, 3. B - 1. 3. C - 2. 4. D = 4 only. E = All

Answer 13

A

Question 14

The Glasgow coma scale is an important tool for assessment of patients with decreased
responsiveness. For the following vignettes, indicate what is the correct score.
Patient appears awake but is confused. Obeys commands briskly although the patient lias
to be re-directed to the task. Eyes are open immediately on examination.
A. 11
B. 12
C. 13
D. 14
E. 15

Answer 14

D

Question 15

The Glasgow coma scale is an important tool for assessment of patients with decreased
responsiveness. For the following vignettes, indicate what is the correct score.
Patient is unresponsive to stimulation, does not open eyes or orient to the examiner. No
speech. All limbs have extensor posturing in response to noxious stimulation.
A. 3
B. 4
C. 5
D. 6
E. 7

Answer 15

B

Question 16

The following disorders are in the differential diagnosis of stupor and coma. For each of
the clinical presentations, select the most likely diagnosis.
A. Catatonia
B. Locked-in syndrome
C. Pseudocoma
D. Vegetative state

Patient is mute with markedly decreased motor activity. When brought to a body posture,
the position is maintained. Patient is - able to wit and stand.

Answer 16

A

Question 17

The following disorders are in the differential diagnosis of stupor and coma. For each of
the clinical presentations, select the most likely diagnosis.
A. Catatonia
B. Locked-in syndrome
C. Pseudocoma
D. Vegetative state
Patient is unresponsive with normal reflexes and tone. Diagnostic studies including MRI
and EEG are normal.

Answer 17

C

Question 18

The following disorders are in the differential diagnosis of stupor and coma. For each of
the clinical presentations, select the most likely diagnosis.
A. Catatonia
B. Locked-in syndrome
C. Pseudocoma
D. Vegetative state

Patient presents with failure to move any extremity to command, but is able to move
eyes, particularly vertically on command.

Answer 18

B

Question 19

The following disorders are in the differential diagnosis of stupor and coma. For each of
the clinical presentations, select the most likely diagnosis.
A. Catatonia
B. Locked-in syndrome
C. Pseudocoma
D. Vegetative state

Patient with a severe head injury has resolution of cerebral edema but is unresponsive to
command and question. EEQ shows preserved sleep-wake cycle.

Answer 19

D

Question 20

All of the following are features of the locke J-in syndrome except which one?
A. Inability to accept input from the environment
B Ability to communicate using eye blinks and vertical eye movements
C. Lesion in the ventral pons, bilaterally
D. Quadriplegia with lower cranial nerve palsies

Answer 20

A

Question 21

affecting the brainstem is associated with which of the following features? Increased
intracranial piessure with cerebral herniation
L Decreased level of consciousness to the point of unresponsiveness
2. Asymmetric third and/or sixth cranial nerve palsies
3. increased blood pressure
4. Decreased heart rate
Select A = i. 2, 3. B = i, 3. C = 2. 4. D = 4 only. E = All

Answer 21

E

Question 22

Differentiating toxic-metabolic from structural causes of coma is a common important
task in clinical diagnosis. For each of the following questions, select the clinical
association.
A. Toxic-metabolic
B. Structural
C. Both
D. Neither
Small symmetric but reactive pupils.

Answer 22

A

Question 23

Differentiating toxic-metabolic from structural causes of coma is a common important
task in clinical diagnosis. For each of the following questions, select the clinical
association.
A. Toxic-metabolic
B. Structural
C. Both
D. Neither
Papilledema.

Answer 23

B

Question 24

Differentiating toxic-metabolic from structural causes of coma is a common important
task in clinical diagnosis. For each of the following questions, select the clinical
association.
A. Toxic-metabolic
B. Structural
C. Both
D. Neither
Progressive decline in level of consciousness.

Answer 24

C

Question 25

Differentiating toxic-metabolic from structural causes of coma is a common important
task in clinical diagnosis. For each of the following questions, select the clinical
association.
A. Toxic-metabolic
B. Structural
C. Both
D. Neither
Asymmetric muscle tone.

Answer 25

B

Question 26

All of the following statements regarding prognosis following coma arc true EXCEPT
which?
A. Metabolic causes such as hepatic encephalopathy have generally a worse
prognosis than cerebrovascular causes of coma
B. Prognosis is generally poor for nontraumatic coma
C. Patients with traumatic coma may have satisfactory improvement even
following months of coma
D. Patients with nontraumatic coma who have not awoken within one month are
unlikely to subsequently recover

Answer 26

A

Question 27

Brain death criteria mandate which of the following?
1. Patient in coma, showing no response to any modality of stimulation
2. No spontaneous respirations even with careful apnea testing
3. A.bsence of brainstem reflexes
4. Absence of cerebral blood flow
Select: A = i, 2, 3. B - 1. 3. C = 2. 4. D = 4 only. E – All

Answer 27

A

Question 28

Question 6-1:
Which of the following statements about frontal lobe localization arc true?
A. Orbitofronta! cortex is involved in emotional states
B. Frontal cortex has extensive connections with the limbic system
C. The frontal lobes are involved in emotional states, appetites, and drives
D. Frontal lobes have connections with autonomic systems
E. All of the above

Answer 28

E

Question 29

Which of the following statements are true regarding the effects of cerebral lesions on
cognitive functioning?
A. Ejroca’s aphasia is produced by a left temporal lesion
B. Wernicke’s aphasia is produced by a left frontal lesion
C. Multiple lesions have a greater cognitive impact than solitary lesions
D. Gerstmann’s syndrome is produced by a right parietal lesion
E. All are true

Answer 29

C

Question 30

Which of the following are typical features of Gerstmann's syndrome?
A. Acalculia
B. Finger agnosia
C. Left-right confusion
D. Agraphia
E. Ail of the above

Answer 30

E

Question 31

Folstein’s mini-mental status examination is probably the most commonly used bedside
mental status assessment. A patient scores perfectly on all of the components except as
noted for the following two questions. Select the answer for the mini-vignettes.

Misses two of the serial-7 calculations and does not know the city. What is the MMSE
score?
A. 25
B. 26
C. 27
D. 28

Answer 31

C

Question 32

Folstein’s mini-mental status examination is probably the most commonly used bedside
mental status assessment. A patient scores perfectly on all of the components except as
noted for the following two questions. Select the answer for the mini-vignettes.

Misses one element on registration but then is able to recall all three objects at five
minutes. On the three-stage command, fails to place paper on the table but rather hands it
back to the examiner. What is the MMSE score?
A. 26
B. 27
C. 28
D. 29

Answer 32

C

Question 33

Which of the following features is characteristic of the split-brain patients?
A. Alien hand syndrome
B. Akinetic mutism
C. Conduction aphasia
D. left- right confusion

Answer 33

A

Question 34

A 26-year-old man with a history of severe head injury presents with an awake
appearance but he does not respond to the environment. There is little movement of the
extremities. Which of the following are likely to be true?
1. The predominant lesion is in the temporal lobes bilaterally
2. If he recovers, he is likely to have disinhibition
3. He has the locked-in syndrome
4. He exhibits akinetic mutism
Select: A = I._ 2, 3. B - I, 3. C — 2,4, D — 4 only. E = All

Answer 34

C

Question 35

Amnestic syndrome is characterized by vvhich of the following features?
1. Impaired recent memory
2. Impaired immediate memory
3. Preserved long-term memory
4. Impaired cognitive function
Select: A = K 2, 3. B = 3. 3. C = 2.4. O = 4 only. E = All

Answer 35

B

Question 36

The Wada test is performed before temporal lobe surgery for epilepsy, What is the main
purpose of this procedure?
A. Identification of which side of the brain is most important for memory
B. Determination of whether resection of the tested brain tissue will control seizures
C. Identification of pre-existing temporal lobe damage which would piedispose to the amnestic syndrome in the event of temporal lobectomy
D. All of these

Answer 36

C

Question 37

Which if the following are features of transient global amnesia?
1. Anterograde and retrograde amnesia
2. Repeats questions
3. Is amnestic for the episode after recovery’
4. May have DWI abnormalities on MRI during the episode.
Select: A = 1,2,3. B = i, 3. C = 2,4. D - 4 only. E = All

Answer 37

E

Question 38

The following lisis some structures which are integral lo memory for certain types of tasks. For the following questions stating types of memory, seiect the best answer for the brain region integral to that type of memory.
A. Neocortex
B. Medial temporal lobe
C. Basal ganglia
D. Cerebellum
E. C & D
Memory for riding a bicycle.

Answer 38

E

Question 39

The following lisis some structures which are integral lo memory for certain types of tasks. For the following questions stating types of memory, seiect the best answer for the brain region integral to that type of memory.
A. Neocortex
B. Medial temporal lobe
C. Basal ganglia
D. Cerebellum
E. C & D
Classical conditioning. Association of a specific stimulus with a specific response.

Answer 39

D

Question 40

The following lisis some structures which are integral lo memory for certain types of tasks. For the following questions stating types of memory, seiect the best answer for the brain region integral to that type of memory.
A. Neocortex
B. Medial temporal lobe
C. Basal ganglia
D. Cerebellum
E. C & D
Probabilistic classification memory - such as predicting the weather from associated cues.

Answer 40

C