NPS Neuro MSK Rosh N6221 Exam-
Graded A
Parkinson's - ANS-A 66-year-old woman presents to her clinician with increasing
rigidity, slow movements, and a tremor. Her family reports no family history of
neurodegenerative disease. On physical exam, the patient has an immobile facial
expression, notable drooling, and infrequent blinking. She responds slowly but
appropriately to questions, though a slight stutter is present. Based on the information
provided, which of the following is the most likely diagnosis?
Crossed straight leg raise test - ANS-A 62-year-old woman presents with low back pain
after lifting heavy boxes while moving earlier today. She describes the pain as a
shooting that radiates from her low back down the back of her left leg. Her vital signs
are within normal limits. On physical exam, she has weakness with plantar flexion and
hypoesthesia extending from her buttocks, down the posterior aspect of her leg. X-rays
are negative for acute fracture. Which of the following additional physical exam findings
is most specific for the patient's suspected diagnosis?
Serum albumin level - ANS-An 85-year-old man presents to your office with complaints
of two recent nonsyncopal falls. He tells you that he feels more uncoordinated and often
gets dizzy when walking. He has a 20-year history of a seizure disorder treated with
phenytoin. On physical examination, he has horizontal nystagmus and an unsteady gait.
His body mass index is 18 kg/m2 and his vital signs, including in-office orthostatic blood
pressure readings, are normal. In addition to obtaining a serum phenytoin level, what is
another important lab value to obtain in this patient?
Difficulty performing fine motor tasks - ANS-A 70-year-old, right-handed man presents
to the office with his wife. He reports feeling increasingly "clumsy" for the past six
months. His wife notes that he walks more slowly than usual and shuffles his feet when
he walks. On physical examination, he has difficulty performing rapid pronation and
supination of his forearms and exhibits "cogwheeling" with passive range of motion of
his upper extremities that is worse on the right side. Which of the following additional
symptoms is this patient most likely to report?
Cranial nerve V - ANS-A 45-year-old man presents to the clinic with brief episodes of
stabbing facial pain triggered by talking and eating. His neurological exam is normal and
vital signs are stable. Based on the patient's presentation, the provider suspects the
impingement of which cranial nerve?
Phenytoin - ANS-Which antiepileptic medication requires a dosing adjustment for
patients with hypoalbuminemia?
, Carbamazepine
(commonly see hyponatremia) - ANS-Which of the following antiepileptic medications
prevents seizures by blocking neuronal sodium channels to prolong the refractory
period and inhibit action potential propagation?
Pragmatics - ANS-A 2-year-old girl presents to clinic for a well check. Her mother
reports that she says only "mama" and "dada" but understands and follows directions.
You discuss that there may be a problem either with the production of speech or with
higher-level language development. Which of the following basic components of
language refers to the social understanding and application of language?
Rotator cuff injury - ANS-A 31-year-old man presents to the clinic with right shoulder
pain for 1 day. He states that he is a children's baseball coach, and he believes he hurt
his shoulder during practice. During the physical examination, the clinician asks the
patient to hold his right arm straight out to his side and slowly lower his arm down. The
patient is unable to slowly adduct his arm and instead, his arm drops to his side. Which
of the following is the most likely diagnosis?
Celecoxib - ANS-Which of the following nonsteroidal anti-inflammatory drugs is
associated with the lowest risk of gastrointestinal bleed?
Induction of CYP3A4 isoenzymes - ANS-A 27-year-old woman with a history of
migraines presents to the clinic for a routine follow-up examination. She is in disbelief
when she is informed her urine pregnancy test has returned positive. The patient
reports medication compliance. Her medication profile consists of an oral contraceptive
and an antiepileptic drug with FDA-approved indications for migraine prophylaxis and
chronic weight management. Which of the following drug interactions is most likely to
have precipitated this event, based on her medication profile?
Melatonin - ANS-Which of the following dietary supplements is recommended as
complementary medicine for children with autistic spectrum disorder?
Partial opioid agonist and antagonist - ANS-A 1-week-old girl presents to the clinic for
her first well-child check. Her mother has a history of opioid use disorder and has been
on buprenorphine as a treatment. She has been on this regimen since before her
pregnancy and follows regularly with her physician to adjust the dose. What is the
mechanism of action of buprenorphine?
Weight loss to accomplish BMI 25 or less - ANS-Osteoarthritis is a progressive loss of
cartilage along with reactive changes in the joints resulting in pain and stiffness. After
diagnosis of osteoarthritis involving the knees, which nonpharmacologic treatment is
recommended?
Graded A
Parkinson's - ANS-A 66-year-old woman presents to her clinician with increasing
rigidity, slow movements, and a tremor. Her family reports no family history of
neurodegenerative disease. On physical exam, the patient has an immobile facial
expression, notable drooling, and infrequent blinking. She responds slowly but
appropriately to questions, though a slight stutter is present. Based on the information
provided, which of the following is the most likely diagnosis?
Crossed straight leg raise test - ANS-A 62-year-old woman presents with low back pain
after lifting heavy boxes while moving earlier today. She describes the pain as a
shooting that radiates from her low back down the back of her left leg. Her vital signs
are within normal limits. On physical exam, she has weakness with plantar flexion and
hypoesthesia extending from her buttocks, down the posterior aspect of her leg. X-rays
are negative for acute fracture. Which of the following additional physical exam findings
is most specific for the patient's suspected diagnosis?
Serum albumin level - ANS-An 85-year-old man presents to your office with complaints
of two recent nonsyncopal falls. He tells you that he feels more uncoordinated and often
gets dizzy when walking. He has a 20-year history of a seizure disorder treated with
phenytoin. On physical examination, he has horizontal nystagmus and an unsteady gait.
His body mass index is 18 kg/m2 and his vital signs, including in-office orthostatic blood
pressure readings, are normal. In addition to obtaining a serum phenytoin level, what is
another important lab value to obtain in this patient?
Difficulty performing fine motor tasks - ANS-A 70-year-old, right-handed man presents
to the office with his wife. He reports feeling increasingly "clumsy" for the past six
months. His wife notes that he walks more slowly than usual and shuffles his feet when
he walks. On physical examination, he has difficulty performing rapid pronation and
supination of his forearms and exhibits "cogwheeling" with passive range of motion of
his upper extremities that is worse on the right side. Which of the following additional
symptoms is this patient most likely to report?
Cranial nerve V - ANS-A 45-year-old man presents to the clinic with brief episodes of
stabbing facial pain triggered by talking and eating. His neurological exam is normal and
vital signs are stable. Based on the patient's presentation, the provider suspects the
impingement of which cranial nerve?
Phenytoin - ANS-Which antiepileptic medication requires a dosing adjustment for
patients with hypoalbuminemia?
, Carbamazepine
(commonly see hyponatremia) - ANS-Which of the following antiepileptic medications
prevents seizures by blocking neuronal sodium channels to prolong the refractory
period and inhibit action potential propagation?
Pragmatics - ANS-A 2-year-old girl presents to clinic for a well check. Her mother
reports that she says only "mama" and "dada" but understands and follows directions.
You discuss that there may be a problem either with the production of speech or with
higher-level language development. Which of the following basic components of
language refers to the social understanding and application of language?
Rotator cuff injury - ANS-A 31-year-old man presents to the clinic with right shoulder
pain for 1 day. He states that he is a children's baseball coach, and he believes he hurt
his shoulder during practice. During the physical examination, the clinician asks the
patient to hold his right arm straight out to his side and slowly lower his arm down. The
patient is unable to slowly adduct his arm and instead, his arm drops to his side. Which
of the following is the most likely diagnosis?
Celecoxib - ANS-Which of the following nonsteroidal anti-inflammatory drugs is
associated with the lowest risk of gastrointestinal bleed?
Induction of CYP3A4 isoenzymes - ANS-A 27-year-old woman with a history of
migraines presents to the clinic for a routine follow-up examination. She is in disbelief
when she is informed her urine pregnancy test has returned positive. The patient
reports medication compliance. Her medication profile consists of an oral contraceptive
and an antiepileptic drug with FDA-approved indications for migraine prophylaxis and
chronic weight management. Which of the following drug interactions is most likely to
have precipitated this event, based on her medication profile?
Melatonin - ANS-Which of the following dietary supplements is recommended as
complementary medicine for children with autistic spectrum disorder?
Partial opioid agonist and antagonist - ANS-A 1-week-old girl presents to the clinic for
her first well-child check. Her mother has a history of opioid use disorder and has been
on buprenorphine as a treatment. She has been on this regimen since before her
pregnancy and follows regularly with her physician to adjust the dose. What is the
mechanism of action of buprenorphine?
Weight loss to accomplish BMI 25 or less - ANS-Osteoarthritis is a progressive loss of
cartilage along with reactive changes in the joints resulting in pain and stiffness. After
diagnosis of osteoarthritis involving the knees, which nonpharmacologic treatment is
recommended?
