HEMATOLOGY AND NEUROLOGY MULTIPLE CHOICE QUESTIONS

                                                                           

                                                                 NEUROLOGY 



All are true about Creutzfeldt-Jakob Disease, except:

It is a neurodegenerative disease caused by prions

Accumulation in the brain of a normal protease-resistant prion protein

An elevated level of 14-3-3 protein in CSF

It is subacute dementia with rapid clinical progression 

B

What is true about Huntington Disease?:

Life expectancy is 20 years from the time of diagnosis

Multiple abnormal  CAG triplet repeats on chromosome 5

Anticipation is related to less severe disease

Multi9ple abnormal GAA triplet repeats on chromosome 9

A

Patient with Parkinson's Disease, his primary symptom is tremor. Which is the best medication?:

Amantadine

Benztropine

Selegiline

Entacapone

A

Mechanism of action of amantadine?:

A weak non-competitive NMDA receptor antagonist

It blocks the peripheral conversion of levodopa

Anticholinergic

MAO-B inhibitor

A

Mechanism of action of ropinirole and bromocriptine?:

MAO-B inhibitor

COMT inhibitor

Dopamine agonist

Anticholinergic

C

Mechanism of action of Selegiline?:

Anticholinergic

COMT inhibitor

Dopamine agonist

MAO-B inhibitor

D

Mechanism of action of Entacapone and tolcapone?:

Anticholinergic

COMT inhibitor

Dopamine agonist

MAO-B inhibitor

B

Mechanism of action of Benztropine and trihexyphenidyl?:

Anticholinergic

COMT inhibitor

Dopamine agonist

MAO-B inhibitor

A

What is the most often primary cancer in metastatic brain tumors?:

Breast cancer

GI tract cancer

Melanoma

Lung cancer

D

Symptoms of increased intracranial pressure?:

Nausea, vomiting, headache, and confusion

Nausea, vomiting, headache, and diplopia

Fever, weight loss, and headache

Headache, fever, and nuchal rigidity

B

Diagnostic criteria for Neurofibromatosis 1, except:

Café-au-lait spots

Optic glioma

Lisch nodules

Bilateral vestibular schwannomas

D

Patient with a history of Meningioma and neurofibroma. What is the diagnosis?: 

Neurofibromatosis 1

Neurofibromatosis 2

Tuberous Sclerosis

Sturge-Weber disease

B

What structures are included in the limbic system?:

Caudate, putamen, globus pallidus, substantia nigra, and subthalamic nucleus

Habenula, habenular commissure, posterior commissure, and the pineal gland

Subthalamic nucleus, red nucleus, and substantia nigra

Amygdala, hippocampus, fornix, mammillary bodies, cingulate gyrus, and parahippocampal gyrus

D

What structures are included in Basal ganglia?:

Caudate, putamen, globus pallidus, substantia nigra, and subthalamic nucleus

Habenula, habenular commissure, posterior commissure, and the pineal gland

Subthalamic nucleus, red nucleus, and substantia nigra

Amygdala, hippocampus, fornix, mammillary bodies, cingulate gyrus, and parahippocampal gyrus

A

What structures are included in the Epithalamus?:

Caudate, putamen, globus pallidus, substantia nigra, and subthalamic nucleus

Habenula, habenular commissure, posterior commissure, and the pineal gland

Subthalamic nucleus, red nucleus, and substantia nigra

Amygdala, hippocampus, fornix, mammillary bodies, cingulate gyrus, and parahippocampal gyrus

B

What structures are included in the Subthalamus?:

Caudate, putamen, globus pallidus, substantia nigra, and subthalamic nucleus

Habenula, habenular commissure, posterior commissure, and the pineal gland

Subthalamic nucleus, red nucleus, and substantia nigra

Amygdala, hippocampus, fornix, mammillary bodies, cingulate gyrus, and parahippocampal gyrus

C

Pathway in Papez circuit?:

Fornix  hippocampus  mammillary bodies  mammillothalamic tract  anterior nucleus of the thalamus  thalamocingulate radiation  cingulate gyrus  hippocampus

Hippocampus  mammillary bodies  fornix  mammillothalamic tract  anterior nucleus of the thalamus  thalamocingulate radiation  cingulate gyrus  hippocampus

Hippocampus  fornix  mammillary bodies  mammillothalamic tract  anterior nucleus of the thalamus  thalamocingulate radiation  cingulate gyrus  hippocampus

Hippocampus  fornix  mammillary bodies  mammillothalamic tract  anterior nucleus of the thalamus  cingulate gyrus  thalamocingulate radiation hippocampus

C

What is the function of the ventromedial nucleus?:

Satiety 

Hunger

Heat dissipating

Heat conservation

A

What is the function of the anterior hypothalamus?:

Satiety

Hunger

Heat dissipating

Heat conservation

C

What is the function of the posterior hypothalamus?:

Satiety

Hunger

Heat dissipating

Heat conservation

D

What is the function of the lateral area of the hypothalamus?:

Satiety

Hunger

Heat dissipating

Heat conservation

B

What is the function of suprachiasmatic nuclei?:

Heat conservation

Heat dissipating

Circadian rhythms

Synthesis of vasopressin and oxytocin

C

What is the function of supraoptic and paraventricular nuclei?:

Heat conservation

Heat dissipating

Circadian rhythms

Synthesis of vasopressin and oxytocin

D

The classic triad of Wernicke encephalopathy?:

Encephalopathy, ophthalmoplegia, and ataxia

Encephalopathy, ophthalmoplegia, and anterograde amnesia

Encephalopathy, ophthalmoplegia, and retrograde amnesia

Encephalopathy, horizontal nystagmus, and confabulations

A

Signs and symptoms of Korsakoff dementia?:

Encephalopathy, ophthalmoplegia, and ataxia

Encephalopathy, ophthalmoplegia, ataxia, amnesia, and confabulations

Encephalopathy, ophthalmoplegia, ataxia, and tremor

Encephalopathy, ophthalmoplegia, ataxia, and paraplegia

B

Which vitamin deficiency causes Wernicke encephalopathy?:

Vitamin B12

Vitamin B9

Vitamin B3

Vitamin B1

D

Which vitamin deficiency causes peripheral neuropathy?:

Vitamin B12

Vitamin B9

Vitamin B3

Vitamin B1

A

What is the etiology of Closed-Angle Glaucoma?:

Obstruction of drainage pathways by the iris

Decreased drainage due to damaged trabecular meshwork

Macular degeneration

Retinal vascular occlusion

A

What is the etiology of Open-Angle Glaucoma?:

Obstruction of drainage pathways by the iris

Decreased drainage due to damaged trabecular meshwork

Macular degeneration

Retinal vascular occlusion

B

Treatment for Open-Angle Glaucoma?:

Isoproterenol

Timolol

Furosemide

Atropine

B

The lesion in the left optic nerve and defect in the visual field?:

Right anopia

Right homonymous hemianopsia

Left homonymous hemianopsia

Left anopia

D

The lesion in the optic chiasm and defect in visual field?:

Central scotoma

Left hemianopia with macular sparing

Bitemporal hemianopsia

Right homonymous hemianopsia

C

The lesion in the right optic tract and defect in visual field?:

Right homonymous hemianopsia

Left homonymous hemianopsia

Left lower quadrantic  anopsia

Right lower quadrantic anopsia

B

The lesion in left dorsal optic radiation?:

Right lower quadrantic anopsia

Left lower quadrant anopsia

Right upper quadrantic anopsia

Left upper quadrantic anopsia

A

The lesion in right Meyer Loop and defect in the visual field?:

Right lower quadrantic anopsia

Left lower quadrant anopsia

Right upper quadrantic anopsia

Left upper quadrantic anopsia

D

Left PCA infarction and defect in the visual field?:

Left hemianopsia with macular sparing

Right hemianopsia with macular sparing

left lower quadrantic anopsia

right lower quadrantic anopsia

B

Macular degeneration and defect in visual field?:

Hemianopsia with macular sparing

Upper quadrantic anopsia

Lower quadrantic anopsia

Central scotoma

D

What is true about central retinal artery occlusion?:

Swollen optic disc with hemorrhages

Retinal hemorrhages

Cotton-wool spots

Cherry-red spot of the fovea

D

What is true about central retinal vein occlusion?:

Retinal swelling

Bloodless retinal arteries

Cotton-wool spots

Cherry-red spot

C


                                                               HEMATOLOGY


Most common coagulation disorder in Ashkenazi Jews?:

Hemophilia A

Hemophilia B

Hemophilia C

Von Willebrand Disease

C

Mechanism of action of Heparin?:

Inhibits synthesis of vitamin K-dependent coagulation factors

Directly inhibit factor Xa

Inhibits factor II

Activates antithrombin

D

Mechanism of action of Warfarin?:

Inhibits synthesis of vitamin K-dependent coagulation factors

Directly inhibit factor Xa

Inhibits factor II

Activates antithrombin

A

Mechanism of action of Apixaban?:

Inhibits synthesis of vitamin K-dependent coagulation factors

Directly inhibit factor Xa

Inhibits factor II

Activates antithrombin

B

Mechanism of action of Dabigatran?:

Inhibits synthesis of vitamin K-dependent coagulation factors

Directly inhibit factor Xa

Inhibits factor II

Activates antithrombin

D

Mechanism of action of tPA?:

Inhibits synthesis of vitamin K-dependent coagulation factors

Directly inhibit factor Xa

Converts plasminogen into plasmin which breaks down fibrin

Activates antithrombin

C

The best initial test in the diagnosis of Hemophilia?

PTT

Mixing study

Specific factor assays

PT

B

Most accurate test in the diagnosis of Hemophilia?:

PTT

Mixing study

Specific factor assays

PT

C

What is the most common inherited bleeding disorder?:

Von Willebrand Disease

Hemophilia A

Bernard-Soulier syndrome

Glanzmann thrombasthenia

A

What is the most common cause of hereditary thromboembolic disease?:

Antithrombin III deficiency

Protein C deficiency

Factor V Leiden

Protein S deficiency

C

In which condition is seen decreased agglutination on the ristocetin cofactor assay?

Factor V Leiden

Von Willebrand disease

Bernard-Soullier syndrome

Glanzmann thrombasthenia

B

What is the condition caused by a deficiency in GpIIb/IIIa?:

 Factor V Leiden

Von Willebrand disease

Bernard-Soullier syndrome

Glanzmann thrombasthenia

D

What is the condition caused by a deficiency in GpIb?:

Factor V Leiden

Von Willebrand disease

Bernard-Soullier syndrome

Glanzmann thrombasthenia

C

What is the mechanism of action of Clopidogrel and ticlopidine?:

Inhibits ADP receptor

Inhibits GpIIb/IIIa

Inhibits COX 

Inhibits factor II

A

Lab findings in Von Willebrand disease?:

Increased bleeding time

Decreased PTT

Increased PT

Decreased platelet count

A

What is the cause of Idiopathic thrombocytopenic purpura?:

Deficiency of ADAMTS-13

IgG antibodies against patient’s platelets

Depletion of clotting factors and platelets

PF4 antibody 

B

What is the cause of Thrombotic Thrombocytopenic  Purpura?:

Deficiency of ADAMTS-13

IgG antibodies against patient’s platelets

Depletion of clotting factors and platelets

PF4 antibody 

A

What is the cause of Heparin-induced Thrombocytopenia?:

Deficiency of ADAMTS-13

IgG antibodies against patient’s platelets

Depletion of clotting factors and platelets

PF4 antibody 

D

What is the cause of tissue necrosis following warfarin administration?:

Vitamin C and S deficiency

Vitamin K deficiency

Activation of protein C

Activation of protein S

A

Clinical presentation and lab findings in TTP?:

Hemolytic anemia increased creatinine and low platelets without neurologic symptoms

Hemolytic anemia increased creatinine, low platelets, increased TP, increased bleeding time

Hemolytic anemia, increased creatinine, low platelets, seizure, and fever

Hemolytic anemia, increased creatinine, low platelets, retroperitoneal bleeding, and fever

C

Clinical presentation and lab findings in HUS?:

Hemolytic anemia increased creatinine, and low platelets without neurologic symptoms

Hemolytic anemia increased creatinine, low platelets, increased TP, increased bleeding time

Hemolytic anemia, increased creatinine, low platelets, seizure, and fever

Hemolytic anemia, increased creatinine, low platelets, retroperitoneal bleeding, and fever

A

Best initial abortive therapy for Migraine?:

Gabapentin 

Triptans

NSAIDs

Dihydroergotamine 

C

Prophylaxis for Migraine includes, except: 

a) Propanolol

b) Amitriptyline

c) Triptans

d) Topiramate

C

Best initial abortive therapy for Cluster headaches?:

a) 100% O2

b) NSAIDs

c) Triptans

d) Acetaminophen

A

Best prophylactic therapy for Cluster headache?:

a) Valproate

b) Propanolol

c) Amitriptyline

d) Verapamil

D

A 34-year-old patient presents with severe, shooting pain, 6/10, on the right side of his face. It lasts less than one minute and presents several times during the day. He states the pain is worse after chewing or brushing his teeth. He denies fever, changes in his vision, lacrimation, rhinorrhea, nausea, or vomiting. What is the best explanation for his condition?:

a) Migraine

b) Trigeminal neuralgia

c) Cluster headache

d) Temporal arteritis

B

What is the first-line therapy for the condition of the previous patient?:

a) Verapamil

b) Valproate

c) Carbamazepine

d) Steroids

C

 37-year-old female patient presents to ED for severe, constant, pressure-like headache (worst pain of my life), 10/10, that started suddenly this morning while she was exercising. The pain is getting worse, doesn’t alleviate with anything. It is associated with nausea, vomiting, photophobia. The physical exam is remarkable for the presence of the Brudzinski sign. What is the best initial step?:

a) Lumbar puncture and CSF analysis

b) CT scan of the head without contrast

c) CT scan of the head with contrast

d) MRI brain

B

 First-line therapy in children with partial or tonic-clonic seizures?:

a) Levetiracetam

b) Phenytoin

c) Carbamazepine

d) Phenobarbital

D

First-line therapy for Absence seizures?:

a) Valproic acid

b) Levetiracetam

c) Ethosuximide

d) Carbamazepine

C

Which is the best initial therapy in status epilepticus?:

a) Midazolam

b) Phenytoin

c) Phenobarbital

d) Lorazepam

D

A patient is still in status epilepticus after 20 minutes besides the administration of benzodiazepines every 5 minutes, which is the best next step?:

a) Continue benzodiazepine for 20 more minutes

b) Start Phenytoin

c) Start Fosphenytoin

d) Start Phenobarbital

C

When is recommended continuous EEG monitoring?:

a) In convulsive status epilepticus

b) Patient does not wake up after clinically obviously seizures stop

c) During alcohol withdrawal

d) During benzodiazepines withdrawal

B

A 55-year-old patient presents in ED with sudden severe vertigo, nausea, vomiting, and difficulty standing up. He was diagnosed with URI 10 days ago. The physical exam is remarkable for vertical nystagmus and gait unsteadiness. He has a past history of Hypertension, DM T1, and CHF. What is the best initial step?:

a) Diffusion-weighted MRI

b) Start meclizine

c) Start steroids

d) Start NSAIDs

A

In the presentation of Benign Paroxysmal Positional Vertigo, which one is incorrect?:

a) Vertigo lasts < 1 min

b) It is not associated with hearing loss

c) Epley maneuver can resolve the symptoms

d) Meclizine is the best initial therapy

D

In Labyrinthitis, which of the following symptoms is incorrect?:

a) Lacking hearing loss

b) Tinnitus

c) Ear fullness

d) Nausea and vomiting

A

What is correct about Ménière's disease?:

a) Recurrent episodes of vertigo, tinnitus, nausea, vomiting, and hearing loss

b) Acute vertigo, nausea, vomiting, and hearing loss after a recent URI

c) Acute vertigo and nystagmus triggered by changes in head position

d) Acute vertigo, nausea, vomiting without hearing loss after a recent URI

A

What is correct about Vestibular neuritis?:

a) Recurrent episodes of vertigo, tinnitus, nausea, vomiting, and hearing loss

b) Acute vertigo, nausea, vomiting, and hearing loss after a recent URI

c) Acute vertigo and nystagmus triggered by changes in head position

d) Acute vertigo, nausea, vomiting without hearing loss after a recent URI

D

Lab findings in Iron Deficiency Anemia?:

High ferritin, high RDW, high TIBC, low serum iron

Low ferritin, low RDW, high TIBC, low serum iron

Low ferritin, high RDW, high TIBC, low serum iron

Low ferritin, low RDW, low TIBC, low serum iron

C

Lab findings in Anemia of Chronic Disease?:

High ferritin, low serum iron, normocytic anemia

Low ferritin, low serum iron, microcytic anemia

High ferritin, high serum iron, normocytic anemia

Low ferritin, high serum iron, normocytic anemia

A

Lab findings in Megaloblastic Anemia due to B12 deficiency?:

Macrocytic anemia increased MMA and increased homocysteine

Macrocytic anemia, normal MMA, and increased homocysteine

Macrocytic anemia, normal MM, and normal homocysteine

Macrocytic anemia, increased MMA, and normal homocysteine

A

Lab findings in Megaloblastic Anemia due to B9 deficiency?:

Macrocytic anemia increased MMA and increased homocysteine

Macrocytic anemia, normal MMA, and increased homocysteine

Macrocytic anemia, normal MM, and normal homocysteine

Macrocytic anemia, increased MMA, and normal homocysteine

B

What is the most common cause of osteomyelitis in patients with Sickle Cell Disease?:

S aureus

Salmonella

S epidermidis

Shigella

B

What is false about complications in Sickle Cell Disease?:

Splenic sequestration resulting in hypovolemia

Parvovirus B 19 infection resulting in aplastic crisis

Low platelets

Increased PTT

D

What is true about Warm Autoimmune Hemolytic Anemia?:

Presence of IgM antibodies

Presence of IgG antibodies

It is associated with Mycoplasma pneumonia

It is associated with Mononucleosis

B

What is true about Cold Autoimmune Hemolytic Anemia?:

Presence of IgG antibodies to RBC antigens

It is associated with Mycoplasma pneumonia

It is associated with Mononucleosis

It is associated with SLE

D

All are true about Hereditary spherocytosis, except?:

Presence of spherocyte

Positive osmotic fragility tests

Negative direct Coombs test

Positive direct Coombs test

D

What is not a cause of Aplastic Anemia?:

HIV infection

Parvovirus B 19 infection

Sulfa drugs

Ciprofloxacin

D

What is not true about Thalassemia?:

African, Middle Eastern, and Asian descent are mostly affected

Microcytic anemia with normal serum iron

Microcytic anemia with low serum iron

Most patients with Thalassemia do not require treatment

C

What is not present in hyperviscosity syndrome ?:

Easy bruising

Blurred vision

Pruritus after a cold bath

Thrombosis

C

What is the best initial test in the diagnosis of Polycythemia Vera?:

JAK 2 mutation

CBC

CBC with an ABG and EPO level

EPO levels

C

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