Which brain stem structure plays a major role in determining the direction from which a sound originates?

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Question 1 of 5

Which brain stem structure plays a major role in determining the direction from which a sound originates?

Correct Answer: D

Rationale: The superior olivary nucleus detects sound direction via intensity and time differences. TMP13 pp. 681-682

Question 2 of 5

Which of the following is a sign of increased intracranial pressure?

Correct Answer: D

Rationale: Increased intracranial pressure (ICP) often manifests as irritability, along with headache, vomiting, and altered consciousness. Hypotension (likely a typo for hypertension) is a late sign with bradycardia (Cushing’s triad), not tachycardia. Tinnitus is unrelated to ICP.

Question 3 of 5

A 30-year-old female presents with muscle weakness in the lower extremities and palpitations. Her symptoms have been progressively worse over the course of a 2 weeks. She reports to be in great health, but had a period of abdominal pain and diarrhea approximately 5 weeks ago. Her temperature is 98.9 deg F (37.2 deg C), blood pressure 117/82 mmHg, pulse is 102/min, and respirations are 16/min. On physical exam, there is 4-/5 muscle strength throughout the lower extremities. Bilateral patellar reflexes are 1+ and ankle reflexes are absent. Lumbar puncture was performed, and results are pending. Part 1: What is the most likely diagnosis?

Correct Answer: B

Rationale: Progressive weakness post-GI illness, reduced reflexes, and palpitations (possibly autonomic involvement) suggest Guillain-Barre syndrome, an acute demyelinating neuropathy. Polymyositis involves proximal weakness without reflex loss, hypokalemia causes generalized weakness with normal reflexes, and myasthenia gravis is fatiguable.

Question 4 of 5

A 31-year-old female presents with throbbing right-sided headache that she rates as 8/10 in intensity. She states her pain began approximately 12 hours ago, and is accompanied by nausea. She finds some relief when sitting in a quiet, dark room. She reports that prior to the onset of her headache, she noticed a 'bright spot' in her left lateral vision that later expanded to form a crescent with 'zigzagging' lines of color that has made her feel as if she was 'blind.' This lasted 30 minutes and then resolved, and was followed by the headache. She experiences similar episodes approximately once every two months. Physical exam is completely normal. Which of the following is the most appropriate initial step in management?

Correct Answer: B

Rationale: Migraine with aura (visual scotoma) and throbbing headache with nausea/photophobia responds acutely to triptans (e.g., sumatriptan). Ondansetron treats nausea, propranolol is prophylactic, and verapamil is for cluster headaches.

Question 5 of 5

A 72-year-old male is brought by his wife due to unexplained weakness and fatigue. She describes his movements as 'sluggish', and is concerned that he may be depressed. The patient reports difficulty with buttoning his shirt, and double clicking the mouse when using his computer. He states that the recent death of his mother has been difficult to accept, and has noticed his foods don't smell the same, and has been having difficulty with sleep. He does not smoke, but drinks 2-3 beers per week. He says his father suffers from a hand tremor, and his mother passed away from pancreatic cancer. On physical exam, a tremor affecting the right hand improves with purposeful movement. There is an increased resistance to passive movement at the right wrist joint. Which of the following is the best initial treatment?

Correct Answer: C

Rationale: Bradykinesia, rigidity, and rest tremor (improving with action) with anosmia suggest Parkinson’s disease. Levodopa is the initial treatment, replenishing dopamine. Primidone is for essential tremor.

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