SG FINAL MASTER PRACTICE QUESTIONS AND
CORRECT ANSWERS ALREADY GRADED A+
GUARANTEED SUCCESS
Case
A 57-year-old man presents to the ED with altered mental status of unknown period.
He was found down in his apartment an hour ago by his visiting nurse, who last saw
him normal in the morning, about 6 hours ago.
He appears to be an unreliable historian and is oriented only to himself. Vitals are
unremarkable.
On exam, he is lethargic and slurring his speech. There is no evidence of trauma, but
you do see some muscle wasting, ascites, spider telangiectasias, and foul-smelling
breath. Mini-mental status exam reveals a score of 16/30. Neurological exam shows
hyperactive deep tendon reflexes globally, poor finger-to-nose coordination, and
flapping of his hands when outstretched and dorsiflexed. Skin turgor is normal.
A review of his chart shows chronic hepatitis C with cirrhosis and portal
hypertension. Ethanol, ASA, acetaminophen, and drug screen are negative.
Question
Considering the overall presentation, which additional finding confirms the
diagnosis?
Elevated PT/INR
Case
You are present on the field as the sports medicine provider at the sidelines of a
college football game. Gameplay is stopped when an on-field head-to-head collision
occurs, and one of your players is laying on the field motionless. The patient is a 21-
year-old male in otherwise sound health with no past medical history. He is
unconscious.
1
,Vitals are well within normal, but he takes about 30 seconds to regain consciousness.
He is unable to recall the collision or the instructions his coach gave him prior. The
last thing he remembers is the scoring drive from 10 minutes ago. He describes a
dull global headache. Cranial nerves and peripheral motor/sensorium are fully
present. He is alert and oriented to person, place, and time. His vision is unchanged.
You follow him as he is carted off the field to the university hospital with spinal
precautions; you find his gait/coordination to be normal. GCS is 15. Careful removal
of his helmet fails to reveal any direct injury to the scalp.
CT of the head fails to reveal any intracranial abnormalities.
After some more careful observation, his GCS remains at 15 without seizures or
change of behavior. He agrees to stay out of the game and out of contact practices.
A week later, he returns to you with complaints of headaches, dizziness, fatigue,
mood swings, and insomnia without focal neurological deficits.
Question
Given the most likely diagnosis, what should be done next?
Brain MRI
Case
You are present on the field as the sports medicine provider at the sidelines of a
college football game. Gameplay is stopped when an on-field head-to-head collision
occurs; one of your players is laying on the field motionless. The patient is a 21-
year-old man in otherwise sound health with no past medical history. He is
unconscious.
Vitals are well within normal, but he takes about 30 seconds to regain consciousness.
He is unable to recall the collision or the instructions his coach gave him prior. The
last thing he remembers is the scoring drive from 10 minutes ago. He describes a
dull global headache. Cranial nerves and peripheral motor/sensorium are fully
present. He is alert and oriented to person, place, and time. His vision is unchanged.
You follow him as he is carted off the field to the university hospital with spinal
precautions; you find his gait/coordination to be normal. GCS is 15. Careful removal
of his helmet fails to reveal any direct injury to the scalp.
CT of the head fails to reveal any intracranial abnormalities and his cervical spine is
cleared. After some more careful observation, his GCS remains at 15 without
2
,seizures or change of behavior. He lives in an apartment with one of his teammates.
He insists on returning to the game.
Question
What should your next course of action be?
Admit for inpatient observation
Case
A 29-year-old woman with a history of relapsing-remitting multiple sclerosis comes
to the office due to increased muscle spasticity and cramps in her legs and decreased
sensation in her arms and legs. The patient is compliant with her medications. She
reports that she has just returned from a skiing vacation to Colorado. While on
vacation, the patient reports smoking marijuana and relaxing in a hot tub. She also
states she has started taking vitamin D supplements.
Question
Which part of her history likely contributed to the change in her symptoms?
Hot tub use
Case
A 65-year-old woman comes to the medical clinic following a fall in a parking lot
earlier that day. She reports that it is more difficult for her to "get started" whenever
she stands to walk. Past medical history is noncontributory. She does not use
tobacco, alcohol, or illicit drugs. She does not take any prescription medication.
Physical examination is notable for an expressionless face, pill-rolling-type resting
tremors of both hands, cogwheel rigidity of the arms, and a shuffling gait. Upon
examination, you also note hypophonia and evidence of a labile mood.
Question
What clinical intervention strategy can be utilized for treatment of hypophonia?
Speech Therapy
Case
A 25-year-old woman presents with involuntary arm and leg movements. She also
has gait instability and memory loss. She denies illicit drug use. She has developed
3
, depression due to her symptoms. Her mother has a history of an autosomal dominant
disorder with similar symptoms. On examination, she has chorea and hyperreflexia.
Question
What is the appropriate clinical intervention?
Tetrabenazine
Case
A 40-year-old woman with no past medical history presents due to numbness and
tingling in her right wrist and hand for the last 6 months. She states that when it
occurs, she shakes her hand to try to relieve the discomfort. She works as an editor
for her company. During examination of her right hand, percussion over the median
nerve causes paresthesia.
Question
What is the appropriate diagnostic test?
Nerve Conduction Studies of the Hand
Case
A 19-month-old boy presents with his parents to the clinic. He has been irritable and
sleeps poorly. He does not maintain eye contact and he has not started walking. His
mother states that he was born early at 30 weeks. His mother and father deny any
family history. On examination, his motor tone in his extremities is decreased and
hyperreflexia is present.
Question
What is the appropriate diagnostic test?
Correct Answer: Magnetic resonance imaging of the brain
Case
A 30-year-old man presents to the ED with concern for a stroke that started when he
awoke from sleep this morning. On exam, you see that he has right-sided facial
paralysis. He cannot close his right eye or raise his right eyebrow. His mouth droops
on that side and he has no tearing in that eye.
Question
4
CORRECT ANSWERS ALREADY GRADED A+
GUARANTEED SUCCESS
Case
A 57-year-old man presents to the ED with altered mental status of unknown period.
He was found down in his apartment an hour ago by his visiting nurse, who last saw
him normal in the morning, about 6 hours ago.
He appears to be an unreliable historian and is oriented only to himself. Vitals are
unremarkable.
On exam, he is lethargic and slurring his speech. There is no evidence of trauma, but
you do see some muscle wasting, ascites, spider telangiectasias, and foul-smelling
breath. Mini-mental status exam reveals a score of 16/30. Neurological exam shows
hyperactive deep tendon reflexes globally, poor finger-to-nose coordination, and
flapping of his hands when outstretched and dorsiflexed. Skin turgor is normal.
A review of his chart shows chronic hepatitis C with cirrhosis and portal
hypertension. Ethanol, ASA, acetaminophen, and drug screen are negative.
Question
Considering the overall presentation, which additional finding confirms the
diagnosis?
Elevated PT/INR
Case
You are present on the field as the sports medicine provider at the sidelines of a
college football game. Gameplay is stopped when an on-field head-to-head collision
occurs, and one of your players is laying on the field motionless. The patient is a 21-
year-old male in otherwise sound health with no past medical history. He is
unconscious.
1
,Vitals are well within normal, but he takes about 30 seconds to regain consciousness.
He is unable to recall the collision or the instructions his coach gave him prior. The
last thing he remembers is the scoring drive from 10 minutes ago. He describes a
dull global headache. Cranial nerves and peripheral motor/sensorium are fully
present. He is alert and oriented to person, place, and time. His vision is unchanged.
You follow him as he is carted off the field to the university hospital with spinal
precautions; you find his gait/coordination to be normal. GCS is 15. Careful removal
of his helmet fails to reveal any direct injury to the scalp.
CT of the head fails to reveal any intracranial abnormalities.
After some more careful observation, his GCS remains at 15 without seizures or
change of behavior. He agrees to stay out of the game and out of contact practices.
A week later, he returns to you with complaints of headaches, dizziness, fatigue,
mood swings, and insomnia without focal neurological deficits.
Question
Given the most likely diagnosis, what should be done next?
Brain MRI
Case
You are present on the field as the sports medicine provider at the sidelines of a
college football game. Gameplay is stopped when an on-field head-to-head collision
occurs; one of your players is laying on the field motionless. The patient is a 21-
year-old man in otherwise sound health with no past medical history. He is
unconscious.
Vitals are well within normal, but he takes about 30 seconds to regain consciousness.
He is unable to recall the collision or the instructions his coach gave him prior. The
last thing he remembers is the scoring drive from 10 minutes ago. He describes a
dull global headache. Cranial nerves and peripheral motor/sensorium are fully
present. He is alert and oriented to person, place, and time. His vision is unchanged.
You follow him as he is carted off the field to the university hospital with spinal
precautions; you find his gait/coordination to be normal. GCS is 15. Careful removal
of his helmet fails to reveal any direct injury to the scalp.
CT of the head fails to reveal any intracranial abnormalities and his cervical spine is
cleared. After some more careful observation, his GCS remains at 15 without
2
,seizures or change of behavior. He lives in an apartment with one of his teammates.
He insists on returning to the game.
Question
What should your next course of action be?
Admit for inpatient observation
Case
A 29-year-old woman with a history of relapsing-remitting multiple sclerosis comes
to the office due to increased muscle spasticity and cramps in her legs and decreased
sensation in her arms and legs. The patient is compliant with her medications. She
reports that she has just returned from a skiing vacation to Colorado. While on
vacation, the patient reports smoking marijuana and relaxing in a hot tub. She also
states she has started taking vitamin D supplements.
Question
Which part of her history likely contributed to the change in her symptoms?
Hot tub use
Case
A 65-year-old woman comes to the medical clinic following a fall in a parking lot
earlier that day. She reports that it is more difficult for her to "get started" whenever
she stands to walk. Past medical history is noncontributory. She does not use
tobacco, alcohol, or illicit drugs. She does not take any prescription medication.
Physical examination is notable for an expressionless face, pill-rolling-type resting
tremors of both hands, cogwheel rigidity of the arms, and a shuffling gait. Upon
examination, you also note hypophonia and evidence of a labile mood.
Question
What clinical intervention strategy can be utilized for treatment of hypophonia?
Speech Therapy
Case
A 25-year-old woman presents with involuntary arm and leg movements. She also
has gait instability and memory loss. She denies illicit drug use. She has developed
3
, depression due to her symptoms. Her mother has a history of an autosomal dominant
disorder with similar symptoms. On examination, she has chorea and hyperreflexia.
Question
What is the appropriate clinical intervention?
Tetrabenazine
Case
A 40-year-old woman with no past medical history presents due to numbness and
tingling in her right wrist and hand for the last 6 months. She states that when it
occurs, she shakes her hand to try to relieve the discomfort. She works as an editor
for her company. During examination of her right hand, percussion over the median
nerve causes paresthesia.
Question
What is the appropriate diagnostic test?
Nerve Conduction Studies of the Hand
Case
A 19-month-old boy presents with his parents to the clinic. He has been irritable and
sleeps poorly. He does not maintain eye contact and he has not started walking. His
mother states that he was born early at 30 weeks. His mother and father deny any
family history. On examination, his motor tone in his extremities is decreased and
hyperreflexia is present.
Question
What is the appropriate diagnostic test?
Correct Answer: Magnetic resonance imaging of the brain
Case
A 30-year-old man presents to the ED with concern for a stroke that started when he
awoke from sleep this morning. On exam, you see that he has right-sided facial
paralysis. He cannot close his right eye or raise his right eyebrow. His mouth droops
on that side and he has no tearing in that eye.
Question
4
