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USMLE Step3 Neurology

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. lesion in dominant parietal lobe
Upright supine position
Taper gradually to prevent seizure relapse
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Difficulty in writing - calculating - distinguishing left and write

2. oligoclonal band in CSF
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
MS
Despite the term neuroma they arise from schwann cells - schwanoma
82% specific for dementia

3. differentiate lewy body dementia and vascular dementia
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Acetylecholinersterase inhibitors
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
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

4. What bp med to be given in a patient with high bp and signs of opioid withdrawal
90% of right handed and 60% of left handed persons; speech and language function
Vitamin B12 deficiency
Clonidine will take care both high bp and withdrawal
Lesion in nondominant temporal lobe

5. 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
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Normal pressure hydrocephalus
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised

6. When to use dopamine agonist pramipexol in parkinson
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Aspirin - control HTN and swallow eval before giving any oral meds
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test

7. women with unilateral eye pain; neurlogic symptoms here there at different times
Vitamin B12 deficiency
Obturator n lesion
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Verapamil

8. acoustic neuroma
Despite the term neuroma they arise from schwann cells - schwanoma
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
RBC count >6000

9. Why V12 deficient develop hypokalemia after tx with b12
Myasthenia; due to autoantibodies against acetylecholine receptor;
Aphasia - neglect - agnosia - acalculia etc
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48

10. How to differentiate medial and lateral medullary syndrome
Get up from chair walk a short distance turn around and sit; screening test for fall
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;
Normal pressure hydrocephalus
Vitamin B12 deficiency

11. How to differentiate parkinson and benign essential tremor
Reduced efficacy of OCP
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
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
Upright supine position

12. How to tx lewy body dementia
Cholinesterase inhibitor; and antiparkinsonism drugs
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
Normal pressure hydrocephalus
Despite the term neuroma they arise from schwann cells - schwanoma

13. brain stem lesion
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Femoral n lesion
Deficit in cranial nerve function
Reduced efficacy of OCP

14. contraindication of sumatripta
Coronary artery disease
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Verapamil
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty

15. best diagnosis for parkinsonim
IVIG and plasmapheresis
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Not within 24 hours; give afte 24-48 hours if patient stable
Autospy gold standard

16. how donepezil - acetylecholinsterase inhibitor works in Alzheimers
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
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
Entacapone - COMT inhibitor
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level

17. what drug is used to extend effects of levodopa
Entacapone - COMT inhibitor
<20; if patient scores >25 benign forgetfulness
Vitamin B12 deficiency
It patient has electrolyte imbalance and hypothermia

18. Unable to copy of matchstick - unable to dress up
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Construction apraxia; lesion in non dominant parietal lobe (right)
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy

19. What percent of dementia is reversible
Botulism has descending paralysis in contrast othere have ascending paralysis
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Nystagmus on far lateral gaze
20%

20. differentiate wenicke and korsakoff
Not within 24 hours; give afte 24-48 hours if patient stable
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
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. lesion in dominant tempora lobe
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Follows viral illness; vertigo - tinnitus - nausea. self limiting
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

22. How to prevent prevent frequency of MS exacerbation
Entacapone - COMT inhibitor
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Difficulty in writing - calculating - distinguishing left and write
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure

23. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
Coronary artery disease
Cerebral palsy; dx mri
Autospy gold standard
90% of right handed and 60% of left handed persons; speech and language function

24. double vision at the end of day and ptosis
Autospy gold standard
Myasthenia; due to autoantibodies against acetylecholine receptor;
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
20%

25. How to differentiate traumatic LP and SAH
Despite the term neuroma they arise from schwann cells - schwanoma
Reduced efficacy of OCP
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48

26. cortical lesion
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Entacapone - COMT inhibitor
Aphasia - neglect - agnosia - acalculia etc
Obturator n lesion

27. infections in GBS
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
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Cerebral palsy; dx mri
EPV - campylobacter - HSV

28. GBS
Not within 24 hours; give afte 24-48 hours if patient stable
IVIG and plasmapheresis
Normal pressure hydrocephalus
Aphasia - neglect - agnosia - acalculia etc

29. earliest sign of phenytoin toxicity
Nystagmus on far lateral gaze
Despite the term neuroma they arise from schwann cells - schwanoma
Get up from chair walk a short distance turn around and sit; screening test for fall
IVIG and plasmapheresis

30. How to diffrentiate tick borne paralysis from GBS and spinal cord tumor
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
Entacapone - COMT inhibitor
<20; if patient scores >25 benign forgetfulness

31. stroke with lower facial palsy - pronator drift despite on aspirin
Deficit in cranial nerve function
Antitoxin
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Aspirin - control HTN and swallow eval before giving any oral meds

32. How to manage stroke patient came within 4 hours
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
<20; if patient scores >25 benign forgetfulness
Construction apraxia; lesion in non dominant parietal lobe (right)
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH

33. How to differentiate botulism from tick born paralysis - GBS and MG
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;
Botulism has descending paralysis in contrast othere have ascending paralysis
Despite the term neuroma they arise from schwann cells - schwanoma
Lesion in nondominant temporal lobe

34. get up and go test
Get up from chair walk a short distance turn around and sit; screening test for fall
It patient has electrolyte imbalance and hypothermia
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
Clonidine will take care both high bp and withdrawal

35. Tx of GBS
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
It patient has electrolyte imbalance and hypothermia

36. Acute onset of left arm weakness
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Diabetes insipidus
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening

37. dominant parietal lobe on the left side
Vitamin B12 deficiency
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
90% of right handed and 60% of left handed persons; speech and language function
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal

38. What mmse score suggest dementia
<20; if patient scores >25 benign forgetfulness
Lesion in nondominant temporal lobe
Corticosteroid and acyclovir
Nystagmus on far lateral gaze

39. excessive elevation of legs during walking (toe touch floor earlier than heels)
Distal lower motor neuron disease
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Lesion in nondominant temporal lobe
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge

40. impaired perception of complex sounds
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;
Lesion in nondominant temporal lobe
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
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

41. walking like drunken sailor; jerky hesitant and walks in zigzag pattern
Cerebellar lesion
Diabetes insipidus
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Cerebral palsy; dx mri

42. differentiate picks and huntington
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
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
MS

43. When to start fibrinolytic therapy in stroke patient?
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
90% of right handed and 60% of left handed persons; speech and language function
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Coronary artery disease

44. When to give aspirin when patient on tPA after stroke
Acetylecholinersterase inhibitors
Coronary artery disease
Not within 24 hours; give afte 24-48 hours if patient stable
Nystagmus on far lateral gaze

45. Most effective to reduce aspiration in stroke or patient with swallowing dysfunction
Cerebral palsy; dx mri
Acetylecholinersterase inhibitors
Upright supine position
High dose IV methyleprednisone;

46. Blood transfusion in hypothermia
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
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
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48

47. craniopharyngioma
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Diabetes insipidus
Reduced efficacy of OCP
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;

48. phenytoin and OCP
Lesion in nondominant temporal lobe
Spastic paraparesis
Entacapone - COMT inhibitor
Reduced efficacy of OCP

49. dementia plus urinary incontinence
Normal pressure hydrocephalus
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Diabetes insipidus
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

50. impaired vibration and increased DTR
82% specific for dementia
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Cholinesterase inhibitor; and antiparkinsonism drugs
Vitamin B12 deficiency