SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
Test your basic knowledge |
USMLE Step3 Neurology
Start Test
Study First
Subjects
:
health-sciences
,
usmle-step-3
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.
1. korsafoff psychosis
Propranolol or primidone
RBC count >6000
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
20%
2. Why V12 deficient develop hypokalemia after tx with b12
Aphasia - neglect - agnosia - acalculia etc
20%
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
<20; if patient scores >25 benign forgetfulness
3. hx of epilepsy - now unresponsive - slight twhiching of mouth and arms
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Nystagmus on far lateral gaze
Upright supine position
4. stroke with lower facial palsy - pronator drift despite on aspirin
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Obturator n lesion
Spastic paraparesis
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
5. How to differentiate medial and lateral medullary syndrome
Antitoxin
MP: paralysis always medial due to involvement of f gracilis and f cunetus - so loss of touch and position sense and injury to hypglossal n in same side; lateral involve spinothalamic which has L; so pain and temp sensation altered;
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Lateral involve trigeminal which has L and has limb ataxia ; medial - ipsilateral limb ataxia and contralateral eye deviation and paralysis of face - arm and leg
6. lesion in dominant tempora lobe
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Aspirin - control HTN and swallow eval before giving any oral meds
Clonidine will take care both high bp and withdrawal
7. When to suspect traumatic LP
Obturator n lesion
RBC count >6000
Follows viral illness; vertigo - tinnitus - nausea. self limiting
If develop fever - mouth ulcer - easy brusing - petechie - see a doc ; the drug cause neutropenia - and bone marrow suppression; elderly are at risk of SIADH
8. best diagnosis for parkinsonim
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Autospy gold standard
Corticosteroid and acyclovir
9. infections in GBS
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Lateral involve trigeminal which has L and has limb ataxia ; medial - ipsilateral limb ataxia and contralateral eye deviation and paralysis of face - arm and leg
EPV - campylobacter - HSV
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
10. What is can be used cluster headache prevention
Verapamil
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
If develop fever - mouth ulcer - easy brusing - petechie - see a doc ; the drug cause neutropenia - and bone marrow suppression; elderly are at risk of SIADH
Cholinesterase inhibitor; and antiparkinsonism drugs
11. When headache is presenting complaint of brain tumor
MP: paralysis always medial due to involvement of f gracilis and f cunetus - so loss of touch and position sense and injury to hypglossal n in same side; lateral involve spinothalamic which has L; so pain and temp sensation altered;
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Diabetes insipidus
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
12. Patient with carbamazepine; What should be advice?
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
L for l ; lewy has lots of hallucination; parkinsonism like features - falls are common; presence lewy body in cytosplasm of brain cells; vascular demential develop very suddenly; hx dm -htn - athero
Get up from chair walk a short distance turn around and sit; screening test for fall
If develop fever - mouth ulcer - easy brusing - petechie - see a doc ; the drug cause neutropenia - and bone marrow suppression; elderly are at risk of SIADH
13. benign essential tremor
Diabetes insipidus
Myasthenia; due to autoantibodies against acetylecholine receptor;
Propranolol or primidone
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
14. lesion in dominant parietal lobe
Vitamin B12 deficiency
Difficulty in writing - calculating - distinguishing left and write
Cerebellar lesion
Aphasia - neglect - agnosia - acalculia etc
15. How to prevent prevent frequency of MS exacerbation
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
MP: paralysis always medial due to involvement of f gracilis and f cunetus - so loss of touch and position sense and injury to hypglossal n in same side; lateral involve spinothalamic which has L; so pain and temp sensation altered;
Both slowly progressive; huntington with abrupt jerk of limb - trunk - grimacing - other abnormal movement - picks are irritable - quiet - sucks lip frequently and have symmetric atrophy of frontal/temporal lobes
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
16. dominant parietal lobe on the left side
90% of right handed and 60% of left handed persons; speech and language function
Difficulty in writing - calculating - distinguishing left and write
Gilberts disease
It patient has electrolyte imbalance and hypothermia
17. How to diffrentiate tick borne paralysis from GBS and spinal cord tumor
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
18. MMSE score of less than 24
Aphasia - neglect - agnosia - acalculia etc
In BET - no resting tremor (tremor worsens at rest and improves with acitivity) - bradykinesia or slowing in voluntary movement; gait difficulty; have positive family hx
82% specific for dementia
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
19. prodrome of vasovagal syncope
Tunnel vision - diaphoresis - nausea - pallor
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Diabetes insipidus
High dose IV methyleprednisone;
20. differentiate wenicke and korsakoff
IVIG and plasmapheresis
Spastic paraparesis
Nystagmus on far lateral gaze
Both in alcoholic; wernicke develop at first with horizontal nystagmus - and ataxia; if not treated they develop memory loss and psychosis which is named korsakoff
21. botulism
Get up from chair walk a short distance turn around and sit; screening test for fall
Antitoxin
Cholinesterase inhibitor; and antiparkinsonism drugs
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
22. What bp med to be given in a patient with high bp and signs of opioid withdrawal
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Clonidine will take care both high bp and withdrawal
Autospy gold standard
Diabetes insipidus
23. construction worker works in squatting position; now develop decreased sensation over anterolateral thigh
Not within 24 hours; give afte 24-48 hours if patient stable
Despite the term neuroma they arise from schwann cells - schwanoma
Cholinesterase inhibitor; and antiparkinsonism drugs
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
24. cluster headache
Construction apraxia; lesion in non dominant parietal lobe (right)
Cluster; l for lacrimation - you for unilateral; episodes occur in cluster/grops; each last 30 min to 3h; c for conjunctival injection; r for retroorbital pain/rhinorhoea
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
25. anerior and anteriomedial thigh paresthesia - decreased DTR
Femoral n lesion
Lesion in nondominant temporal lobe
In BET - no resting tremor (tremor worsens at rest and improves with acitivity) - bradykinesia or slowing in voluntary movement; gait difficulty; have positive family hx
Cholinesterase inhibitor; and antiparkinsonism drugs
26. When to use brain spect scintigraphy to confirm brain death
High dose IV methyleprednisone;
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
It patient has electrolyte imbalance and hypothermia
RBC count >6000
27. alcoholic p/w confusion - ataxia - tremor - nystamgus
Warning
: Invalid argument supplied for foreach() in
/var/www/html/basicversity.com/show_quiz.php
on line
183
28. patient with hx of cluster headache p/w retroorbital pain lacrimation - vomiting suddenly
Myasthenia; due to autoantibodies against acetylecholine receptor;
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Despite the term neuroma they arise from schwann cells - schwanoma
Difficulty in writing - calculating - distinguishing left and write
29. how donepezil - acetylecholinsterase inhibitor works in Alzheimers
Not within 24 hours; give afte 24-48 hours if patient stable
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
If develop fever - mouth ulcer - easy brusing - petechie - see a doc ; the drug cause neutropenia - and bone marrow suppression; elderly are at risk of SIADH
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
30. MG
Get up from chair walk a short distance turn around and sit; screening test for fall
Autospy gold standard
Construction apraxia; lesion in non dominant parietal lobe (right)
Acetylecholinersterase inhibitors
31. brain stem lesion
Cerebral palsy; dx mri
Deficit in cranial nerve function
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Lesion in nondominant temporal lobe
32. at first tingling in toes and feet then weakness in extremities
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
MP: paralysis always medial due to involvement of f gracilis and f cunetus - so loss of touch and position sense and injury to hypglossal n in same side; lateral involve spinothalamic which has L; so pain and temp sensation altered;
Both slowly progressive; huntington with abrupt jerk of limb - trunk - grimacing - other abnormal movement - picks are irritable - quiet - sucks lip frequently and have symmetric atrophy of frontal/temporal lobes
Cerebellar lesion
33. What mmse score suggest dementia
<20; if patient scores >25 benign forgetfulness
Acetylecholinersterase inhibitors
Aphasia - neglect - agnosia - acalculia etc
20%
34. impaired vibration and increased DTR
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Both in alcoholic; wernicke develop at first with horizontal nystagmus - and ataxia; if not treated they develop memory loss and psychosis which is named korsakoff
Vitamin B12 deficiency
First nerulogical exam must demonstrate absent cerebral and brainstem reflexes; absent motor response to pain - absent pupillary reflex - corneal reflex - cough reflex - and tracheal suctioning; then apnea test.
35. contraindication of sumatripta
IVIG and plasmapheresis
Cerebellar lesion
Coronary artery disease
Both slowly progressive; huntington with abrupt jerk of limb - trunk - grimacing - other abnormal movement - picks are irritable - quiet - sucks lip frequently and have symmetric atrophy of frontal/temporal lobes
36. How to differentiate traumatic LP and SAH
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
37. differentiate lewy body dementia and vascular dementia
Cerebellar lesion
Acetylecholinersterase inhibitors
L for l ; lewy has lots of hallucination; parkinsonism like features - falls are common; presence lewy body in cytosplasm of brain cells; vascular demential develop very suddenly; hx dm -htn - athero
Tunnel vision - diaphoresis - nausea - pallor
38. How to perform apnea test
Get up from chair walk a short distance turn around and sit; screening test for fall
High dose IV methyleprednisone;
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
Obturator n lesion
39. When to start fibrinolytic therapy in stroke patient?
Normal pressure hydrocephalus
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
First nerulogical exam must demonstrate absent cerebral and brainstem reflexes; absent motor response to pain - absent pupillary reflex - corneal reflex - cough reflex - and tracheal suctioning; then apnea test.
40. How to stop antiepileptic drugs
Taper gradually to prevent seizure relapse
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Distal lower motor neuron disease
Not within 24 hours; give afte 24-48 hours if patient stable
41. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
MP: paralysis always medial due to involvement of f gracilis and f cunetus - so loss of touch and position sense and injury to hypglossal n in same side; lateral involve spinothalamic which has L; so pain and temp sensation altered;
Aspirin - control HTN and swallow eval before giving any oral meds
Cerebral palsy; dx mri
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
42. impaired hepatic conjugation of billirubin
Gilberts disease
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Get up from chair walk a short distance turn around and sit; screening test for fall
Both slowly progressive; huntington with abrupt jerk of limb - trunk - grimacing - other abnormal movement - picks are irritable - quiet - sucks lip frequently and have symmetric atrophy of frontal/temporal lobes
43. How to tx lewy body dementia
If develop fever - mouth ulcer - easy brusing - petechie - see a doc ; the drug cause neutropenia - and bone marrow suppression; elderly are at risk of SIADH
Pt is asked to hold both arms fully extended at shoulder level in front of him with palms upwards; unable to maintain such position means positive test; closing eye will accentuate the effect
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Cholinesterase inhibitor; and antiparkinsonism drugs
44. oligoclonal band in CSF
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
MS
Upright supine position
Spastic paraparesis
45. Should we tx htn in acute ischemic stroke
Warning
: Invalid argument supplied for foreach() in
/var/www/html/basicversity.com/show_quiz.php
on line
183
46. women with unilateral eye pain; neurlogic symptoms here there at different times
In BET - no resting tremor (tremor worsens at rest and improves with acitivity) - bradykinesia or slowing in voluntary movement; gait difficulty; have positive family hx
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Corticosteroid and acyclovir
47. Unable to copy of matchstick - unable to dress up
Construction apraxia; lesion in non dominant parietal lobe (right)
Vitamin B12 deficiency
Lesion in nondominant temporal lobe
Distal lower motor neuron disease
48. Acute onset of left arm weakness
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Gilberts disease
Normal pressure hydrocephalus
49. headache - non reactive pupil - fall on both sides during walking - impaired upward gaze
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Distal lower motor neuron disease
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Autospy gold standard
50. phenytoin and OCP
Reduced efficacy of OCP
Corticosteroid and acyclovir
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal