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The George Washington University Medical Center Module 8 Post Test: Neurology/Infectious Disease Post Graduate Diploma in Emergency Medicine Name___________________________________________________ Signature________________________________________________ THE MEDICAL FACULTY ASSOCIATES WTIH
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The George Washington University Medical Center 1. Post-exposure prophylaxis of rabies should be given using the following regimen: a. Rabies immunoglobulin, one dose IM b. Rabies immunoglobulin infiltrated mostly into the wound and four doses of rabies c. Rabies vaccine, one dose IM and four doses of immunoglobulin given over 28 d. Rabies immunoglobulin in divided doses IM over 3 weeks. 2. The treatment for toxoplasmosis CNS lesions is: a. Rifampin b. Trimethoprim and sulfamethoxazole c. Pyrimethamine and sulfadiazine d. Ceftriaxone 3. The following helminthic infection can present with obstructive hydroureter: a. Ascaris lumbricoides b. Enterobius c. Schistosoma haematobium d. Taenia solium 4. Plasmodium falciparum has unique characteristics which explain the potential severity of its infection. One of the most significant characteristics is: a. Its exotoxins that cause hemorrhage and coagulopathy. b. It induces the formation of "sticky knobs" on the surface of red blood cells which makes them clump together and clog the microcirculation. c. Its ability to lie dormant in the liver for several years and then reactivate. d. Its paroxysms of fever produce delirium and significant CNS dysfunction 5. Which of the following is an indicator for the case definition of AIDS? a. CD4 cell count < 500 cells/microliter b. CMV retinitis c. Weight loss > 20 lbs d. Oral candidiasis 6. The most common cause of pulmonary infections in HIV-infected patients is: a. Pneumocystis carinii b. Mycobacterium tuberculosis c. Streptococcus pneumoniae d. Cryptococcus neoformans 7. The most common cause of focal encephalitis in patients with AIDS is: Dedicated to saving lives by improving Emergency Care in the United States and around the world. THE MEDICAL FACULTY ASSOCIATES WTIH
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The George Washington University Medical Center b. Toxoplasma gondii c. Herpes simplex virus d. Cytomegalovirus 8. Which of the following statements regarding post-exposure prophylaxis for needlestick a. The risk of transmission of HIV from saliva, feces, urine or vomitus is low unless b. Hollow-bore needles have the same risk of transmission of HIV as do solid c. One-drug regimens are appropriate and sufficient in post-exposure prophylaxis d. Post-exposure HIV prophylaxis medications may be initiated up to three weeks 9. Complications of infectious mononucleosis include all of the following EXCEPT: a. Splenic rupture b. Autoimmune hemolytic anemia c. Cholangitis d. Guillain-Barre syndrome 10. An 18 year old woman presents to the emergency department 2 hours after eating at a Chinese food restaurant and complains of diarrhea and abdominal cramping. Infection by the following foodborne pathogen would be most likely: a. Bacillus cereus b. Cryptosporidium c. Clostridium botulinum d. Yersinia enterocolitica 11. All of the following features indicate the need for a stool culture to be performed, a. Prolonged duration of symptoms b. Immunocompromise c. Vomiting d. Bloody diarrhea 12. Herpes encephalitis has a predilection for which lobe of the brain? a. Occipital b. Temporal c. Parietal d. Frontal Dedicated to saving lives by improving Emergency Care in the United States and around the world. THE MEDICAL FACULTY ASSOCIATES WTIH
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The George Washington University Medical Center 13. A 5 year old child is brought by his father for an itchy rash that appeared 2-3 days ago. The child has a rash that is disseminated over the face and trunk and you notice papules, vesicles, and pustules. The father states the child was feeling sleepy and feverish the day before the rash appeared. The most likely diagnosis is: a. Exanthem subitum b. Rocky Mountain Spotted Fever c. Scarlet fever d. Chickenpox 14. All of the following are possible modes of transmission of malaria EXCEPT: a. Blood transfusion b. Congenitally acquired c. Fecal-oral route d. Sharing of contaminated needles 15. Patients with sickle cell disease are protected against malaria for all of the following a. Cross-immunity from previous bacterial infections b. Accelerated sickling of infected red blood cells c. Enhanced phagocytosis d. Less parasite growth 16. The most important factors in the decision of which agent to use in the treatment of a. Patient age, side effects, level of parasitemia b. Species, resistance patterns, clinical status of the patient c. Immune status, previous prophylactic use, patient age d. Likelihood of compliance, cost, availability of the drug 17. The pathophysiology which explains severe infection due to rabies is: a. Arrhythmia with subsequent sudden cardiac death b. Focal hemorrhage and demyelination of nerves c. Cytokine activation and septic shock d. None of the above 18. The antivirals used to treat HIV infection function by: a. Inhibiting transcription of viral RNA b. Inhibiting invasion by virions into cells c. Blunting the body's immune response to the virus d. Decreasing severity of symptoms due to HIV Dedicated to saving lives by improving Emergency Care in the United States and around the world. THE MEDICAL FACULTY ASSOCIATES WTIH
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The George Washington University Medical Center 19. An HIV patient presents with cough, shortness of breath, and hypoxia. The patient reports a fever at home. His last CD4 count was 150. You perform a CXR which shows no apparent infiltrates. What should you do next? a. Treat for presumed PE, this patient does not have an infection. b. Do a blood culture, and treat for presumed pneumocystis carinii pneumonia. c. Do an EKG as this is most likely acute coronary syndrome. d. Discharge the patient home. 20. In a patient with known HIV, the risk of transmission of HIV to the healthcare worker 21. A 45 year old man with AIDS is found to have pneumocystis pneumonia. His ABG shows a pH of 7.33, pO2 of 58mmHg, PCO2 of 60mmHg, HCO3 of 20, and Base Excess of +2. Your treatment regimen for this patient would include: a. Bactrim or Pentamidine b. Bactrim or Ceftriaxone c. Bactrim and Dexamethasone d. Ceftriaxone and Azithromycin 22. A patient presents with RUQ pain and an ultrasound is done which shows common bile duct dilatation. The patient states they noticed a worm in his stool last week. The most likely causative organism is: a. Necator americanus b. Ascaris lumbricoides c. Enterobius d. Giardia lamblia 23. This organism can be contracted when children are playing in the dirt and can lead to anemia, colitis, and even rectal prolapse: a. Trichuris trichiura b. Enterobius c. Cyclosporidium d. Giardia lamblia 24. Diagnosis of this organism can be made on muscle biopsy, as it has a predilection for striated muscle and is known to cause elevations in CPK. The most likely pathogen is: a. Trichinella spiralis b. Necator americanus c. Strongyloides d. Schistosoma Dedicated to saving lives by improving Emergency Care in the United States and around the world. THE MEDICAL FACULTY ASSOCIATES WTIH
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The George Washington University Medical Center 25. A patient is suspected to have ingested contaminated meat. They present with headache and vomiting. A noncontrast brain CT is obtained which demonstrates multiple cystic lesions without hemorrhage. The most likely diagnosis is: a. Lymphoma b. Brain abscess c. Taenia solium d. Cryptococcus 26. A 76 year old female was recently hospitalized for cholecystitis for one week. She was given antibiotics, observed and improved. One day after arriving home, she developed multiple bouts of watery diarrhea. A stool sample demonstrates positive C. difficile antigen. The most adequate treatment regimen for this patient would be: a. Clindamycin IV b. Amoxicillin PO c. Vancomycin IV d. Metronidazole PO 27. A 65 year old female with history of hypertension presents with right leg weakness and lightheadedness. Her vitals are: HR 90, BP 185/115, 98% on RA, RR 16. On exam, the strength is 5/5 bilaterally in both upper extremities, 5/5 in left lower extremity, and 3/5 in right lower extremity. Reflexes and sensation are equal and symmetric. You suspect this patient may have a stroke in which vascular distribution: 28. Which of the following is a contraindication for using thrombolytics for an ischemic stroke: a. Presentation 2 hours after symptoms started b. Persistant blood pressures of 150/90's 29. Which of the following is true about TIA's? a. TIA's can be ischemic or hemorrhagic b. TIA's reach their maximum severity in 2-5 hours c. TIA's generally resolve in 10-15 minutes d. TIA's are not a precursor to development of a later stroke 30. A 30 year old female presents with vertigo for 1 day. She complains of nausea, but no vomiting. She has no headache, no neurologic signs, and no other complaints. She recently has had a cold, but those symptoms have resolved. On exam, she appears nontoxic with stable vital Dedicated to saving lives by improving Emergency Care in the United States and around the world. THE MEDICAL FACULTY ASSOCIATES WTIH
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The George Washington University Medical Center signs, and she has an extinguishable nystagmus with the slow component to the left. What is the likely cause of the vertigo? 31. How do you distinguish peripheral from central vertigo? a. Central vertigo has non-fatigable nystagmus b. Central vertigo is often associated with tinnitus or hearing loss c. Peripheral vertigo often has an insidious onset d. Peripheral vertigo is often associated with ataxia and gait disturbances 32. A 60 year old male presents with vertigo, nausea, and vomiting. He has nystagmus on exam and is unable to ambulate without assistance. No other deficits are noted. The most likely diagnosis is: 33. A 48 year old patient with history of pulmonary TB presents with seizures that continue despite multiple doses of lorazepam. The next most appropriate drug to administer is: 34. The most common symptom that occurs at the onset of myasthenia gravis is: 35. A 20 year old male presents after head trauma. The patient had +LOC, but had a GCS 15 upon arrival to the ED. The patient is noted to have a large hematoma over the left temporal area. Which injury would you be most concerned about? a. Cerebral contusion b. Epidural hematoma Dedicated to saving lives by improving Emergency Care in the United States and around the world. THE MEDICAL FACULTY ASSOCIATES WTIH
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The George Washington University Medical Center 36. A 35 year old male presents with severe headache that woke him from sleep. He has had similar headaches in the past. On exam, he has lacrimation, flushing, and rhinorrhea on the affected side. The most effective acute therapy is: 37. A 70 year old patient presents with sudden onset of headache with vomiting and ataxia, with a blood pressure of 190/97. What is the most likely etiology? 38. A 30 year old female presents with diplopia. The differential diagnosis includes all of the following except: 39. A 70 year old male presents after an unwitnessed fall in the bathroom, confused per family. Pt is oriented to time and place, but is disoriented to person. The patient is has a hematoma on his left tempo-parietal area and no other focal deficit. The most likely diagnosis is: b. Epidural hematoma c. Subdural hematoma d. Subarachnoid hemorrhage 40. A 67 year old female presents with family confused since she woke up. The patient is moaning and answering questions appropriately with 1-2 words. The patient has no complaints with a non-focal exam and she moves all 4 extremities. The patient's vital signs are: HR 106, BP 101/40, Temp 95F, Pulse Ox 95% room air. What is the most likely diagnosis? 41. A 62 year old female presents with a left sided headache which increased with palpation over left temple. The patient has not had any trauma to her head, but she reports visual changes in her left eye. Management in the emergency department includes all of the following except: Dedicated to saving lives by improving Emergency Care in the United States and around the world. THE MEDICAL FACULTY ASSOCIATES WTIH
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The George Washington University Medical Center d. Arrange follow up with rheumatology in 1-2 weeks 42. Irreversible causes of dementia include all of the following except: 43. The following are causes of acute seizure disorder except: 44. A 28 year old male presents with altered mental status. All of the following should be administered except: 45. All of the following dermatomes are correctly matched except: 46. A patient presents with back pain and left lower extremity weakness and right foot numbness. Rectal tone is decreased. All of the following are true regarding this disease process except: a. It is associated with elevated CSF protein levels b. Patients often have history of intravenous drug abuse d. Overflow urinary incontinence can be seen 47. All of the following are true regarding aspirin intoxication except: b. Tinnitus may be the initial presenting symptom d. Acute liver failure is often the cause of severe morbidity and mortality 48. All of the following are true regarding the Glascow Coma Scale except? Dedicated to saving lives by improving Emergency Care in the United States and around the world. THE MEDICAL FACULTY ASSOCIATES WTIH
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The George Washington University Medical Center a. It was developed for use on trauma patients b. Shock and alcohol intoxication alter the score c. Verbal response is the best one individual indicator d. It is invalid if the patient has a spinal cord injury 49. Migraines are stimulated by all of the following except: a. Oral contraceptives b. Calcium channel blockers c. Chocolate d. Sleep deptrivation 50. A 50 year old male presents with intermittent vertigo for several weeks. The patient has non-extinguishable nystagmus and there is no peripheral component. The following are possible etiologies except: Dedicated to saving lives by improving Emergency Care in the United States and around the world.

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