199575_seleksi Imo Soal.docx

CEREBROVASCULAR DISEASE 1. A 76-year-old man with hypertension complained of a severe headache. Over the course of 15 minutes, he became gradually unable to move the right side of his body and had difficulty speaking. By the time he reached the emergency department, he was arousable, but obtunded. He was weak on the right side and aphasic. Which of the following is the most likely diagnosis? A. Subarachnoid hemorrhage

C

B. Midbrain hemorrhage C. Putaminal hemorrhage D. Lacunar infarction of the left posterior limb of the internal capsule E. Ischemic stroke of the left middle cerebral artery

2. A 76-year-old man with hypertension and diabetes complained of a severe headache. On arrival to the emergency department, he was stuporous, weak on the right side, and aphasic. Which of the following is the most appropriate step in the evaluation of this patient? A. CT B. MRI C. Magnetic resonance angiography

A

D. Catheter angiogram E. Spinal tap and blood cultures 3. Which of the following poses the greatest risk for a basal ganglia hemorrhage? A. Cigarette smoking B. Hypertension C. Poorly controlled diabetes D. Hypercholesterolemia

B

E. Cerebral amyloidosis 4. In which of the following locations is a hypertensive intracerebral hemorrhage UNLIKELY? A. Putamen B. Pons C. Cerebellum D. Midbrain E. Thalamus

D

HEADACHE 1. A 24-year-old, obese woman presented with a 3-week history of headaches. They were present for most of the day and were described as severe, throbbing, and throughout her entire head. She denied any auras or specifi c trigger. She noted that when she sneezed, she lost vision for several seconds. A CT of her brain was normal. Which of the following is the most likely diagnosis?

C

A. Mass lesions causing increased intracranial pressure B. Sinus venous thrombosis C. Idiopathic intracranial hypertension D. Atypical migraine headaches E. Cluster headaches

2. A 26-year-old woman presented with episodes of bilateral visual loss. She said that they most often occurred when she coughed, sneezed, or laughed. She also reported a pulsatile headache for the past few months that was only mildly improved with pain medications. A CT of the brain was normal. Which of the following physical examination fi ndings is most likely to be seen in this patient? A. Papilledema B. Bitemporal hemianopsia C. Downbeat nystagmus D. Oculomotor nerve palsies

A

E. Afferent pupillary defect 3. A 19-year-old woman presented with episodes of bilateral visual loss and a severe pulsatile headache. A CT of the brain was normal. Which of the following is the next most appropriate step in the evaluation of this patient? A. Brain MRI with contrast B. MR angiogram C. MR venogram D. Lumbar puncture to measure opening pressure E. Measure intraocular pressure

D

4. A 42-year-old woman complained of a headache on the right side of her head. It was throbbing and associated with vomiting, phonophobia, and double vision. On examination, her right eye was deviated downward and outward and there was mild ptosis. Which of the following is the most likely diagnosis? A. Vertebral artery dissection B. Carotid artery dissection C. Basilar migraine D. Ophthalmoplegic migraine E. Familial hemiplegic migraine

D

5. A 42-year-old woman presented with a throbbing headache, double vision, and tinnitus. She had a widebased, ataxic gait and a skew deviation. She was tired and confused on mental status exam. The patient reported having several similar episodes in her 30s. A brain MRI showed several nonspecifi c hyperintensities in the white matter. Which of the following is the most likely diagnosis? A. Common migraine B. Migraine with aura C. Migraine with brainstem aura D. Idiopathic intracranial hypertension E. Familial hemiplegic migraine

C

EPILEPSY 1. A 25-year-old woman presented with multiple episodes of altered behavior. Each episode lasted for about 2 minutes, and was associated with lip-smacking movements and repetitive limb movement. The patient did not remember these events, but was able to anticipate them, saying that she felt “butterfl ies in mystomach” and a sense of fear before they occurred. Sometimes she said she smelled burning rubber as well. Which of the following is the most likely diagnosis? A. Focal aware seizure B. Generalized-onset seizure C. Focal to bilateral tonic–clonic seizure D. Focal seizure with impairment of awareness E. Gelastic seizure

D

2. A 25-year-old woman presented with episodes where her right hand curled up and she had an overwhelming sense of fear. Each episode lasted about 90 seconds. She was fully awake and alert despite her psychiatric symptoms. Which of the following is the most likely diagnosis? A. Focal aware seizure

A

B. Generalized-onset seizure C. Focal to bilateral tonic–clonic seizure D. Focal seizure with impairment of awareness E. Gelastic seizure 3. At which of the following ages is epilepsy most likely to present? A. 2 months B. 10 years C. 20 years

A

D. 40 years E. 60 years 4. A 4-year-old boy presented with multiple episodes where he would suddenly lose consciousness and have tonic–clonic movements of his extremities with urinary incontinence and tongue-biting. Which of the following is the best term for this type of seizure? A. Focal aware seizure

B

B. Generalized-onset seizure C. Focal to bilateral tonic–clonic seizure D. Focal seizure with impairment of consciousness E. Absence seizure

INSOMNIA 1. A 26-year-old man had episodes where his muscles would become suddenly weak, and he would fall to the ground after laughing or crying. Which of the following other symptoms does he most likely have? A. Diffi culty with sleep initiation B. Diffi culty with sleep maintenance C. Sleepwalking D. Hypnagogic jerks

B

E. REM sleep behavior disorder 2. Which of the following is more consistent with nightmares than with night terrors? A. The sufferer has no recollection of the event

B. The event occurs during REM sleep C. There is associated diaphoresis, fl ushing, tachypnea D. There are associated vocalizations

B

E. The event occurs earlier in the sleep period

ANOTHER PSYCHIATRY 1. A 28-year-old man was brought to the emergency department by his wife, who said he has been “actings trangely.” After losing his job 3 months ago, he devoted 20 hours per day to a new secretive “project” and will no longer let her in the garage. He was diagnosed with depression at 18 years old after a suicide attempt and has been taking sertraline since that time. The patient said he felt great about his new work for a major international conglomerate and an exposé he is writing about a former employer. He looked around the room suspiciously, spoke rapidly, and paced, saying that he suspects his wife may be spying on him for his former boss. Toxicology screening was positive for marijuana. Which of the following is the most likely diagnosis? A. Bipolar disorder B. Schizophrenia C. Cannabis use disorder D. Adjustment disorder E. Delusional disorder 2. A 25-year old man was brought to the emergency department by the police after being found climbing up the fi re escape of his ex-girlfriend’s building. He was intense, with pressured speech, screaming that the police have kidnapped his wife and are threatening to kill her. He has been searching for 4 days straight. Which of the following treatments is indicated at this time? A. Olanzapine B. Lithium C. Valproate D. Lamotrigine E. Olanzapine and lithium 3. Which of the following laboratory tests is required before starting a patient on lithium? A. Platelets B. Absolute lymphocyte count C. Liver function tests D. Serum creatinine E. Potassium level

4. A 48-year-old man with bipolar disorder presented with abdominal pain. His serum amylase was 896 U/L and serum lipase was 760 U/L. Which of the following medications is most likely responsible for his presentation? A. Valproate B. Lithium C. Carbamazepine D. Topiramate E. Quetiapine 5. A 21-year-old man presented to the clinic for treatment of depression. He reported six depressive episodesdating back to age 15. He also described a 2-week period of decreased need for sleep, increased libido, andincreased goal-directed activity at age 20, which led to his only psychiatric hospitalization. He currentlyreported decreased energy, passive suicidal thoughts, and depressed mood with anhedonia. Which of the following medications is most appropriate at this time? A. Haloperidol B. Venlafaxine C. Sertraline D. Lurasidone E. Buspirone 6. Which of the following symptoms is NOT part of the diagnostic criteria for a manic episode? A. Irritability B. More talkative than usual C. Increase in concentration D. Decreased need for sleep E. Impulsive behavior 7. Which of the following medications is indicated for the prevention of depressive episodes in bipolar disorder? A. Levetiracetam B. Valproate C. Topiramate D. Carbamazepine E. Lamotrigine 8. A 38-year-old woman was brought to the emergency department by her husband who said that she has not slept for three days. She was irritable with pressured speech, and had spent $50,000 in the last week to become a “part owner” of a new restaurant. She said her business partners have been tapping her phone lines, and she plans to “fi nd and get them.” When the psychiatrist recommends hospitalization for treatment

of acute mania, the patient declines and says, “I feel fi ne. I don’t want to go to the hospital.” Which of the following is the most appropriate course of action? A. Start lithium and see the patient in 1 week B. Start valproate and see the patient in 1 week C. Start lithium and see the patient in 2 days D. Start valproate and see the patient in 2 days E. Involuntary psychiatric admission 9. A 41-year-old man presented with insomnia. For the past 2 weeks, he describes sleeping 3 to 4 hours per night but says that his energy during the day is “better than usual.” He has been more productive at work and recently obtained several new clients for his company. He describes his mood as “really good.” There is no recent violent or self-injurious behavior. He describes a previous psychiatric history of depression. You notice that is diffi cult to interrupt his rapid speech. Which of the following describes the patient’s current mood episode? A. Mania B. Hypomania C. Akathisia D. Psychosis E. Narcolepsy 10. You are treating a patient for bipolar II and are called by a neurologist who is seeing your patient for seizure disorder. She wants to add Valproate to his regimen and is letting you know so that you can adjust and monitor which medication in his regimen? (bipolar) A. Lamotrigine B. Sertraline C. Lithium D. Paroxetine E. Clozapine 11. A 56-year-old man with bipolar disorder was generally unable to eat, speak, or move. He lay in bed most of the day staring at the ceiling. If his arms were moved for him, he would leave them in the position in which they were placed. Which of the following treatments is indicated at this time? A. Lithium B. Methylphenidate C. Olanzapine D. Clozapine E. Lorazepam 12. A 60-year-old woman admitted for depression with catatonic features remained symptomatic despite treatment with intramuscular lorazepam. She was not eating or drinking, and had become dehydrated.

Which of the following treatments is indicated at this time? (DEPRESSION) A. Pentobarbital B. Ketamine C. Propofol D. Electroconvulsive therapy E. Transcranial magnetic stimulation 13. A 45-year-old woman presented for treatment of depression. Despite trials of fl uoxetine, nortriptyline, and venlafaxine, she continued to feel depressed with anhedonia and low energy. She had not left her house in several weeks and had lost 20 pounds due to not eating. Which of the following treatments is appropriate at this time? (DEPRESSION) A. Electroconvulsive therapy B. Duloxetine C. Phenelzine D. Lithium E. Methylphenidate

KEY ANS : 1. A 2. E 3. D 4. A 5. D 6. C 7. E 8. E 9. B 10.A 11.E 12.D 13.A

PARKINSONISM 1. An 80-year-old man presented with diffi culty walking. Over the past few months he had a hard time “getting started” and it took him much longer to get up from a chair. On exam, he took small, shuffl ing steps with little ground clearance and had little arm swing. He had a resting tremor of his right arm, which he said had been present for over 1 year. Which of the following is the most likely diagnosis? A. Essential tremor B. Normal pressure hydrocephalus C. Tabes dorsalis D. Parkinson disease E. Cervical spondylosis 2. Which of the following gaits is most characteristic of Parkinson disease? A. A wide-based, lurching gait B. A shuffl ing gait with poor arm swing C. A stiff, “scissoring” gait D. A steppage gait E. A gait apraxia, where patients can mimic walking while seated, but have poor foot clearance when actually trying to walk 3. Which of the following is most characteristic of the tremor in Parkinson disease? A. It improves with moderate alcohol intake B. It worsens with action C. It is most pronounced when patients are asked to hold their arms in front of them D. It is a unilateral, resting tremor E. It is bilateral and symmetric at disease onset 4. Which of the following physical exam fi ndings would be most concerning for a disease other than idiopathic Parkinson disease? A. Unilateral cogwheel rigidity of an arm B. Restriction of vertical gaze C. A decreased blink rate D. Small handwriting

E. Hypophonia 5. Which of the following conditions may precede a diagnosis of Parkinson disease, sometimes by several decades? A. Progressive night blindness B. Schizophrenia C. Migraines D. REM behavior sleep disorder E. Iron-defi cient anemia 6. Accumulation of which of the following proteins underlies the pathology in Parkinson disease? A. Hyperphosphorylated tau B. Dopa decarboxylase C. Alpha-synuclein D. Catechol-O-methyl transferase E. Beta-amyloid 7. In which of the following patients with Parkinson disease would ropinirole be contraindicated? A. A 56-year-old man with coronary artery disease B. A 51-year-old woman with postmenopausal syndrome C. A 65-year-old man with chronic renal insuffi ciency D. A 74-year-old man with mild dementia and paranoia E. A 62-year-old woman with depression and a prior suicide attempt 8. A 69-year-old man presented with stiffness and dizziness when standing. On examination, he was ataxic, with a wide-based gait, intention tremor, and had horizontal jerk nystagmus. His blood pressure was 140/95 mmHg lying down, which fell to 90/60 mmHg when he stood up. Which of the following is most likely to be seen on his MRI? A. Atrophy of the head of the caudate B. Symmetrical hyperintensities of the globus pallidus C. Atrophy of the midbrain D. Degeneration of pontocerebellar fi bers within the pons E. Hyperintensity of the corticospinal tract ANS KEY : 1. D 2. B 3. D

4. B 5. D 6. C

7. D 8. D

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GAMBAR APA? -BRAIN CYST ORGANISME PENYEBAB -TOXOPLASMA GONDII

Seorang ibu 65 th mengeluh nyeri kepala hebat. Ada riwayat HT td 190/130 saat dating. Penurunan kesadaran

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Tip of the basilar Posterior communicating Middle cerebral artery Anterior communicating Anterior cerebral artery Internal carotid