INS Exam 4 Compilation Flashcards
A 31-year-old patient was hospitalized 3h after ingestion of an unknown quantity of phenobarbital. The drug concentration in the plasma was found to be 6 mg/L after admission. Assume that in this patient pharmacokinetic parameters for phenobarbital are as follows: oral bioavailability, 100%, V= 80L, CL = 38L/day; half-life = 2 days. Which of the following dose of phenobarbital patient ingested? (Mukherjee)
600 mg
228 mg
480 mg
160 mg
240 mg
480 mg
A 26-year old electrician has a “Nervous Disposition.” He easily startled, worries about inconsequential matters. Diazepam is prescribed. Diazepam are thought to cause sedative and/or anxiolytic effects by (Mukherjee)
Enhancing the actions of dopamine
Acting as a partial agonist at 5-HT receptors
Increasing functional activity at GABA receptors
Facilitating GABA mediated increases in chloride ion conductance
Blocking the NMDA glutamate receptor subtype
Facilitating GABA mediated increases in chloride ion conductance
In the management of toxicity caused by ingestion of methanol in wood spirits. Which one of the following statements is MOST accurate? (Mukherjee)
Hemodialysis will not remove methanol from blood
Naltrexone is a suitable antidote is poisoning due to methanol
Treatment should involve the administration of disulfiram in the ER
Ethanol will prevent formation of formaldehyde in methanol poisoning
Delirium treatments is characteristics of methanol poisoning
Ethanol will prevent formation of formaldehyde in methanol poisoning
A 25-yaer old young woman suffer from a seizure disorder characterized by tonic rigidity of the extremities followed in 20-30s of tremor progressing of massive jerking of the whole body. This clonic phase last for 1 to 2 mins, leaving the patient in a stuporous state. Which of the following drugs is MOST suitable for her long-term management? (Mukherjee)
Clonazepam
Tiagabine
Ethosuximide
Lamotrigine
Felbamate
Lamotrigine
A 30-year old male patient is on drug therapy for a psychiatric problems for 4 years. He has been recently diagnosed having “long QT syndrome.” Which one of the following drugs used in the management of CNS dysfunction is MOST likely to cause problems in this patient? (Mukherjee)
Alprazolam
Ethosuximide
Buspirone
Lithium
Ziprasidone
Ziprasidone
A 41-year old school teacher is taking haloperidol for a psychotic disorder. Which of the following adverse effects is Likely to occur in this patient? (Mukherjee)
Weight loss
Increase seizure threshold
Orthostatic hypotension
Agranulocytosis
Prolong QT interval
Orthostatic hypotension
A 25 year old woman is brought to the ER by her classmate. She shows following symptoms attributed to a drug over dose. Increase heart rate and blood pressure, Mydriasis, behavioral excitation, aggressiveness, paranoia, and hallucination. Which one of the following drugs is MOST likely to be responsible for these symptoms? (Mukherjee)
Ethanol
Marizuana
Amphetamine
Fentanyl
Codeine
Amphetamine
A 21 year old man is suffering from generalized anxiety disorder (GAD). He has prior history of drug dependence that includes the illicit use of secobarbital and alcohol. The physician also prescribes a drug that can be helpful in GAD and that has the advantage of no abuse liability. The drug prescribed was MOST likely to have been (Mukherjee)
Phenobarbital
Diazepam
Lorazepam
Buspirone
Oxazepam
Buspirone
A college student is brought to the emergency department by friends. The physician is informed that the student had taken a drug and then went “crazy.” The patient is continuously laughing, increased heart rate and reddening of conjunctiva. Which of the following drugs MOST likely to be involved is (Mukherjee)
Cocaine
MDMA, “ecstasy”
Marijuana
Heroin
Phencyclidine
Marijuana
Which of the following drug in overdose is known to cause the potentially fatal “serotonin syndrome?” (Mukherjee)
LSD
Nicotine
MDMA “ecstasy”
Coacaine
Phencyclidine
MDMA “ecstasy”
The intense craving experienced by those who are trying to recover from chronic alcohol abuse can be ameliorated by which of the following drugs? (Mukherjee)
Disulfiram
Fomepizole
Naltrexone
Thiamine
Haloperidol
Naltrexone
A 6 year old child is having learning difficulties at school. Electroencephlogram studies reveal brief 3-HZ spike and wave discharges appearing synchronously in all leads every 5 to 10 min. Which drug would be MOST effective in this child without the disadvantages of excessive sedation or tolerance development? (Mukherjee)
Diazepam
Phenobarbital
Valproic Acid
Clonazepam
Ethosuximide
Ethosuximide
A 32 year old pregnant woman with alcoholism presented to ER in early stages of labor. She consumes large amounts of alcohol beverage throughout her pregnancy. This patient’s infant is at risk of a syndrome that includes (Mukherjee)
Underdevelopment of the lungs
Limn malformation
Mental retardation and craniofacial abnormalities
Spina bifida
Fetal hydration syndrome
Mental retardation and craniofacial abnormalities
Which of the statements concerning the adverse effects of antipsychotic drugs is accurate? (Mukherjee)
Clozapine causes a small but important incidence of agranulocytosis
Renal pigmentation is a dose-dependent toxic effects of clozapine
Blurring of vision and urinary retention are common adverse effects of haloperidol
Failure to ejaculate is not common adverse effects of pehnothiazines
Aripiprazole can cause hyperglycemia, hyperprolactimia or weight gain
Clozapine causes a small but important incidence of agranulocytosis
An antipsychotic drug that is quite sedating and associated with significant weight gain, hyperlipidemia, and increased risk of Type II diabetes is (Mukherjee)
Haloperidol
Aripiprazole
Chlorpromazine
Risperidone
Clozapine
Clozapine
MAO inhibitors
Blocks reuptake of serotonin
Blocks reuptake of norepinephrine and serotonin
Degrades transmitters
Allows transmitters to work for a long time
Increases depression
Allows transmitters to work for a long time
Lithium salts are used prophylactically in treating (Nyanda)
Fear and anxiety
Aggression
Compulsive disorder
Excitement induced urination
Manic depression
Manic depression
The following statements concerning antidepressants are true EXCEPT: (Nyanda)
Patients taking antidepressants exhibit mental and physical dependence
Antidepressants drugs are extremely dangerous especially with the tricyclics
Antidepressants cause weight gain
Antidepressants potentiate effects of alcohols and sedatives
Majority of antidepressants drugs are known to have a short half-life and can be given frequently to calm the patient
Majority of antidepressants drugs are known to have a short half-life and can be given frequently to calm the patient
Which of the following drugs will alleviate an 8 year old boy from bed wetting? (Nyanda)
A. Trazedone
B. Imipramine
C. Fluxetine
D. tranylcypromine
E. Diazepam
B. Imipramine
Which of the following is a tricyclic antidepressant drug? (Nyanda)
A. Diazepam
B. Epinephrine
C. Clozapine
D. Nortriptyline
E. Dopamine
D. Nortriptyline
A 2 year old girl has a history of near-drowning, having been submerged in a semi-frozen lake for 20 minutes. As a result of this experience, there are bilateral infarcts in the hippocampal complex. Which of the following behavioral disorders is this patient most likely to display?
Aphasia
Social crudeness
A loss of long-term memory
A loss of immediate and short-term memory
Hypersexuality
A loss of immediate and short-term memory
The type of receptor that is critical for the induction of hippocampal LTP, by virtue of its admitting calcium into a dendritic spine, is called:
An AMPA receptor
An NMDA receptor
A glycine receptor
A cholinergic GPCR
A noradrenergic GPCR
An NMDA receptor
Weak stimulation of a pathway in the hippocampus will not by itself trigger long-term potentiation. However, if one pathway is weakly activated at the same time that a neighboring pathway onto the same cell is strongly activated, both synaptic pathways undergo long-term potentiation. This phenomenon is termed
Input specificity
State dependent potentiation
Associativity
Retrograde signaling
Habituation
Associativity
Epileptic seizures can be caused by a variety of acquired or congenital factors, including all of the following EXCEPT:
Cortical damage from trauma
Cutting the corpus callosum
Stroke
Tumors
Congenital cortical dysgenesis (failure of the cortex to grow properly)
Cutting the corpus callosum
A 12 year old boy has a seizure in which he experiences loss of consciousness and contraction of all of his muscles. A minute later he fails and begins to jerk, during which his extremities are flexed. His classmates were worried and stood around him as he continued to twitch for about 2 minutes. Soon the twitching subsided and he became immobile, and did not respond to calling of his name or shaking to try to awaken him. As one of his classmates ran for help, the boy began to respond but seemed extremely confused and tired. The classification of this type of seizure is
Absence seizure
Complex partial
Petit mal
Simple partial
Generalized tonic-clonic
Generalized tonic-clonic
Language and speech require the participation of both Wernicke’s area and Broca’s area. These two regions of the brain communicate with each other via a fiber bundle called:
The thalamocortical tract
The arcuate fasciculus
The perforant path
The fornix
Middle forebrain bundle
The arcuate fasciculus
The MRI of a 57 year old, right-handed woman reveals a lesion in the lateral aspect of the left hemisphere involving the inferior frontal gyrus, lateral portions of the pre-and postcentral gyri, the inferior parietal lobule, and portions of the adjacent superior temporal gyrus. Which of the following is the MOST prominent deficit in this patient?
Blindness in the left eye
Aphonia
Paralysis of all eye movement
Language comprehension and use
Right-sided paralysis of the lower extremity
Language comprehension and use
A 72 year old retired butcher suffered a stroke affecting his left posterior temporal lobe. A sample of his speech is as follows: “Boy, I’m sweating, I’m awful nervous, you know, once in awhile I get caught up, I can’t mention the tarripoi, a month ago, quite a litte, I’ve done a lot well, I impose a lot, while, on the other hand, you know what I mean, I have to run around, look it over, trebbin and all that sort of stuff.”
Split-brain
Broca’s aphasia
Wernicke’s aphasia
Aprosodia
Conduction aphasia
Wernicke’s aphasia
A blindfolded Meharry medical student is asked to identify a common object presented to her left hand. She is not allowed to touch the object with her right hand. Which of the following structures must be intact for her to complete this task?
The primary somatic sensory cortex on the left side of her brain
The primary visual cortex on the right side of her brain
The corpus callosum
The fonix
The hippocampus
The corpus callosum
Computerized Tomography (CT):
Is a superior imaging modality than magnetic resonance imaging (MRI) in every way except visualizing calcification
Does not utilize radiation to generate images
Cannot distinctly visualize gray and white matter in the presence or absence of surrounding bony structures
Is not a useful tool to visualize structural shift in brain tissue or CSF volume change
Cannot acquire a whole 3-D volume of brain images
Cannot distinctly visualize gray and white matter in the presence or absence of surrounding bony structures
Magnetic Resonance Imaging (MRI):
Relies upon radio-frequencies to derive anatomical images
Was developed the same year as CT
Does not acquire image volumes in three dimensions
Utilizes the same dipole relaxation rates for fat, protein, CSF and water
Is the safest imaging modality for women of child-bearing age
Relies upon radio-frequencies to derive anatomical images
Magnetic Resonance Spectroscopy (MRS):
Requires CT scans to define anatomic areas of interest
Is most useful in the diagnosis of dementia and mental status changes
Can be utilized to quantify brain metabolite concentrations
Alone can generate anatomic images of psychiatric brain abnormalities
Cannot define metabolism changes that occur with clinical pathology
Can be utilized to quantify brain metabolite concentrations
Single Photon Emission Computed Tomography (SPECT):
Cannot measure cerebral blood flow
Needs magnetic resonance imaging to define brain anatomy
Utilizes a single photon that is detected simultaneous in two directions
Deploys the same radiation theory and procedure as Computerized Tomography to derive brain images
Utilizes MRI to detect radiation
Needs magnetic resonance imaging to define brain anatomy
Positron Emission Tomography (PET):
Cannot be utilized for brain receptor studies targeting specific neurotransmitters
Is a non-invasive imaging procedure
Is less expensive than Computerized Tomography imaging
Has less image resolution than Single Photon Emission Computerized Tomography
Utilizes a photon detecting device that does not generate anatomic images
Utilizes a photon detecting device that does not generate anatomic images
Significant bone density is a major disadvantage of:
Computerized tomography
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Single photon emission computed tomography
Positron Emission Tomography
Computerized tomography
Magnetic Resonance Imaging (MRI):
Uses T2 sequences to define tumor location
Uses T1 sequence that are no better than CT to localize anatomy in the occipital area of the brain
Uses T1 sequences for anatomical resolution that are much better than CT
Uses T1 sequences that are better than T2 to localize white matter and gray matter difference
Uses T2 sequences that are no better than Magnetic Resonance spectroscopy to localize anatomy in the occipital area of the brain
Uses T2 sequences to define tumor location
Functional Magnetic Resonance Imaging (fMRI):
Generates its images from changes in hemoglobin concentrations
Generates its images from changese in cerebral blood flow rates
Generates its images from X-rays
Generates its images from radioactive tracers
Generates its images from changes in neurotransmitter receptor densities
Generates its images from changes in hemoglobin concentrations
A 26 year old female student reports hearing “a strange male voice” while alone in her room, telling her to move things around. The LEAST likely diagnosis is:
Schizophrenia
Rest of answer choices are missing
Schizophrenia
Which is true about Schizophrenia?
It is sufficient to demonstrate catatonic behavior to be diagnosed with schizophrenia
Males are disproportionally affected with schizophrenia
Substance abuse is rare among female patients with schizophrenia
A particular disturbance, which should last at least six months
Both mono and dizygotic twins have about 10% of concordance rate for schizophrenia
A particular disturbance, which should last at least six months
A 68 year old man comes to the office with complaints of memory loss. He says he forgets where puts items, names of familiar people and what he is about to do. He continues with his duties as treasurer of his civic club. His wife says he seems normal to her. His examination is normal except for a MMSE score of 29 out of a possible 30; he missed one of three words to remember after 3 minutes. What is the most likely diagnosis?
Age associated memory change
Mild cognitive impairment
Dementia of the Alzheimer type
Lewy body disease
Age associated memory change
A 68 year old man is brought to the office by his family because of memory loss. Patient insists he is normal. Family relates instances of short term memory loss, disorientation, difficulty with house hold chores, and inability to correctly handle financial matters. His examination is normal except for a MMSE score of 21 out of a possible 30. What is the most likely diagnosis?
Age associated memory change
Mild cognitive impairment
Dementia of the Alzheimer type
Lewy body disease
Dementia of the Alzheimer type
A 68 year old man comes to the office with complaints of memory loss. He says he forgets where he puts items, names of familiar people and what he is about to do. He continues with his duties as treasurer of his civic club. However, he must make lists of tasks to do or else he will forget them. Wife says he has bad memory but normal otherwise. His examination is normal except for a MMSE score of 27 out of a possible 30; he could not remember any of the 3 words after three minutes. What is the most likely diagnosis?
Age associated memory change
Mild cognitive impairment
Dementia of the Alzheimer type
Lewy body disease
Mild cognitive impairment
A 67 year old man comes to your office with his wife. Both report that he has had mental changes. He has reported seeing little people in the house. They are not threatening but follow him around. He wanders in the neighborhood and has gotten lost on a few occasions. On several occasions he has fallen for no known reason. On exam he has an expressionless face. There is a resting tremor and the motor tone is increased in a cog wheel type rigidity. On the Mini Mental State Examination he missed 2 of the 3 words to remember after 3 minutes, and he had difficulty copying the drawing of intersecting pentagons. Which of the following diagnoses are more likely?
Normal pressure hydrocephalus
Lewy body disease
Multi-infarct dementia
Parkinson’s disease dementia
A and B
B and D
B and D
Cholinesterase inhibitors are indicated in various disorders of memory disturbance. Which of the following should not be expected from their use?
Temporary stabilization of global function and cognition in a demented patient
Inhibit the transition from mild cognitive impairment to dementia
Reduce time burden on care giver for a Alzheimer’s disease patient
Delay nursing home placement for a Alzheimer’s disease patient
Inhibit the transition from mild cognitive impairment to dementia
When evaluating a patient with probably Alzheimer’s disease you plan a series of tests to answer what question(s)
Are there amyloid plaques in the brain
How severe is the Alzheimer’s disease
Is there another possible cause of patient’s symptoms
Does the patient have Parkinson’s disease
Is there another possible cause of patient’s symptoms
Characteristics of normal pressure hydrocephalus that help in distinguishing it from Alzheimer’s disease are all of the one below except
Difficulty initiating walking (apraxia of gait)
Urinary and fecal incontinence
Normal appearance and ability to carry on a superficial conversation
Decrease spontaneous activity and reduced level of interest
Normal appearance and ability to carry on a superficial conversation
Causes of dementia are:
Multiple strokes
Normal pressure hydrocephalus
Creutzfeld-Jakob (prion) disease
Lewy body disease
A, C, and D
All of the above
All of the above
Basic science and clinical studies have led to an understanding of the basic defect underlying the Lambert-Eaton syndrome. Which of the following best characterizes this defect? (Chirwa)
The production of excess quantities of acetylcholine
The production of antibodies that act against nicotinic Ach receptors
A reduction in brain catecholamines
Reduction in presynaptic Ca++ channels
Viral encephalitis
Reduction in presynaptic Ca++ channels
While reviewing the lecture note from Dr. Chirwa, a group of freshmen found that there are several agents that act pre-synaptically and inhibit cholinergic functions. Which of the following agents inhibits cholinergic activity by blocking the storage of Ach into its vesicles? (Maleque)
Alpha-bungarotoxin
Botulinum toxin
Vesamicol
Hexamethonium
Tubocurarine
Vesamicol
Which of the following drugs is an antagonist at nicotinic (N1) receptors? (Maleque)
Atropine
Dopamine
Succinylcholine
Trimethaphan
Acetylcholine
Trimethaphan
Visual field loss in the nasal visual field of each eye most likely reflects pathology where>
The optic chiasm
The temporal lobes
The occipital lobe
Both eyes
Both eyes
Local anesthetic agents act primarily:
At a cortical level to decrease the patient’s awareness of pain impulses
At the neuromuscular junction to decrease frequency of pain impulses reaching the CNS
On the axon membrane to prevent depolarizing potentials
At ganglion sites to decrease central pain input
On the muscle membrane to decreasing blood flow
On the axon membrane to prevent depolarizing potentials
A 35 year old woman has recently started a regiment of antipsychotic therapy with a typical neuroleptic drug. A side effect of her medication is that she begins to lactate. This side effect is due to the fact that neuroleptic drugs block receptors in the pituitary gland for which of the following substances?
Epinephrine
Dopamine
Glycine
Norepinephrine
Serotonin
Dopamine
A 75 year old woman with dementia showed a loss of neurons from the septal nuclei in the basal forebrain region of the cerebrum. Some cognitive improvement occurred when she was treated with a drug to enhance the function of these neurons. This drug most likely enhanced signaling in the brain from which of the following types of neuron?
Adrenergic
Cholinergic
Dopaminergic
Glutaminergic
Serotonergic
Orexin/Hypocretin
Cholinergic
Histamine cells projecting to the cerebellar cortex originate in which of the following?
Hypothalamus
Pontine nuclei
Olivary nucleus
Reticular nucleus
Raphe nuclei
Locus coeruleus
Hypothalamus
Pyridoxine deficiency associated with isoniazid can result in seizures due to
Glutamate neurotoxicity
GABA deficiency
Cholinergic deficiency
Serotonin syndrome
Dopamine deficiency
GABA deficiency
Areas where the blood-brain barrier is compromised include which of the following?
Anterior thalamic nucleus
Hypothalamic Paraventricular nucleus
Pineal gland
Frontal cortex
Intermediolateral column of spinal cord
Pineal gland
Lesions of the cerebellum cause dysarthria. On the neurological examination, dysarthria is characterized by
Errors in direction and force of movement, i.e. pastpointing
Unsteady gait
Intentional tremor
Slow and slurred speech
Inability to maintain an upright posture
Slow and slurred speech
Which of the following is TRUE regarding children with a diagnosis of Autism?
The vast majority of them will have an Axis II diagnosis of mental retardation
Their auditory processing skills may be abnormal
Their receptive and functional communication skills will be subnormal
They will need special education consistent with Public Law 94-992
All of the above
A, B, and C, only
A and B, only
A, B, and C, only
Children with developmental learning disabilities:
Are often mentally retarded, also
Have normal general/globial intelligence
Often “grow out” of their disabilities
Must receive psychological testing from a physician before a diagnosis is made
All of the above
Have normal general/globial intelligence
Males are more likely to exhibit which of the following disorders:
Prader-Willi syndrome, mental retardation and autism
Learning disabilities, Klinefelter’s syndrome, conduct disorder
Attention Deficit Hyperactivity Disorder, Gender Identity Disorder
Fragile X syndrome, Rett’s Disorder, Maple Syrup Urine Disorder
All of the above
A, B, and C, only
None of the above
A, B, and C, only
The case of the brain injury of U.S. congresswoman Gabrielle Giffords gives students of Integrated Neuroscience an up-close and ongoing opportunity for synthesizing their knowledge of the subject, since her medical progress has largely been reported in the public domain. Hence, we may make the following statements regarding Congresswoman Giffords:
Her rehabilitation has been excellent relative to the 6 to 112 month general expectation for brain injury recovery
Her microsystem, mesosystem, and exosystem and chronosystem factors have converged to forma prognostically positive context for her recovery
She has received medical care that the vast majority of Americans would not receive following a brain injury
All of the above
All of the above
With regard to Congresswoman Giffords, we may also say that:
There are many parallels between her brain injury and that of Phineas Gage
The Chronosystem of Phineas Gage was superior to that of the Congresswoman
The frontal cortex was impacted in both the cases of Gage and Giffords
The Exosystem of Phineas Gage was superior to that of the Congresswoman
All of the above
A and C, only
B and D, only
A and C, only
Which of the following regarding Congresswoman Giffords is FALSE?
Her corpus callosum was impacted by the bullet
Her right side motor ability was more impacted than the left side
Her language skills were more affected than her creative skills
Plasticity may account for some of her recovery
ALL of the above
Her corpus callosum was impacted by the bullet
Which of the item(s) is/are FALSE regarding the Wechsler intelligence scales and the Stanford-Binet Scale?
Z-scores have a mean of 100 and a SD of 15
T-scores have a mean of 50 and a SD of 10
Mild mental retardation may be denoted by an IQ of 65
Medical students must score at the 150+ IQ level as part of admissions testing
A and C, only
B and D, only
B and D, only
Which of the following statement(s) is/are TRUE regarding the Minnesota Multiphasic Personality Scale II
It is a projective personality test (it is objective)
It is comprised of 550 true-false items
Raw scores are converted to Z-scores with a mean of 50 and a SD of 10 (T scores, not Z)
It consists of 10 clinical dimensions/scales and 3 validity scales
A and B, only
B and D, only
B and D, only