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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. cortical lesion
Wernicke's encephalopathy; due to thiamine definition; medical emergency
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
Aphasia - neglect - agnosia - acalculia etc
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy

2. MMSE score of less than 24
Coronary artery disease
Reduced efficacy of OCP
Get up from chair walk a short distance turn around and sit; screening test for fall
82% specific for dementia

3. When to suspect traumatic LP
RBC count >6000
Aspirin - control HTN and swallow eval before giving any oral meds
Entacapone - COMT inhibitor
20%

4. get up and go test
Deficit in cranial nerve function
Cholinesterase inhibitor; and antiparkinsonism drugs
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;
Get up from chair walk a short distance turn around and sit; screening test for fall

5. craniopharyngioma
Tunnel vision - diaphoresis - nausea - pallor
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Diabetes insipidus
Reduced efficacy of OCP

6. brain stem lesion
Deficit in cranial nerve function
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Entacapone - COMT inhibitor

7. Unable to copy of matchstick - unable to dress up
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Construction apraxia; lesion in non dominant parietal lobe (right)
IVIG and plasmapheresis
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.

8. How to confirm braindeath?
MS
Femoral n lesion
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
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.

9. what drug is used to extend effects of levodopa
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
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
Entacapone - COMT inhibitor
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

10. how donepezil - acetylecholinsterase inhibitor works in Alzheimers
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
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
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;
MS

11. How to differentiate parkinson and benign essential tremor
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
<20; if patient scores >25 benign forgetfulness
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure

12. benign essential tremor
Propranolol or primidone
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
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;

13. construction worker works in squatting position; now develop decreased sensation over anterolateral thigh
Obturator n lesion
Coronary artery disease
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised

14. MG
Acetylecholinersterase inhibitors
Cerebral palsy; dx mri
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
<20; if patient scores >25 benign forgetfulness

15. lesion in dominant tempora lobe
High dose IV methyleprednisone;
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
90% of right handed and 60% of left handed persons; speech and language function

16. How to differentiate medial and lateral pontine syndrome
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Spastic paraparesis
RBC count >6000
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

17. oligoclonal band in CSF
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
MS
Corticosteroid and acyclovir

18. Tx of bells palsy
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Vitamin B12 deficiency
Corticosteroid and acyclovir

19. at first tingling in toes and feet then weakness in extremities
It patient has electrolyte imbalance and hypothermia
Deficit in cranial nerve function
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
High dose IV methyleprednisone;

20. How to tx acute exacerbation of MS
Autospy gold standard
High dose IV methyleprednisone;
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
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS

21. phenytoin and OCP
Aspirin - control HTN and swallow eval before giving any oral meds
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
IVIG and plasmapheresis
Reduced efficacy of OCP

22. How to differentiate botulism from tick born paralysis - GBS and MG
Reduced efficacy of OCP
Botulism has descending paralysis in contrast othere have ascending paralysis
Entacapone - COMT inhibitor
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure

23. When to give aspirin when patient on tPA after stroke
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
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Not within 24 hours; give afte 24-48 hours if patient stable
Cholinesterase inhibitor; and antiparkinsonism drugs

24. 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
IVIG and plasmapheresis
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure

25. Why V12 deficient develop hypokalemia after tx with b12
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
<20; if patient scores >25 benign forgetfulness
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Cerebral palsy; dx mri

26. Patient with carbamazepine; What should be advice?
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; 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
Myasthenia; due to autoantibodies against acetylecholine receptor;
High dose IV methyleprednisone;

27. How to tx lewy body dementia
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
EPV - campylobacter - HSV
Cholinesterase inhibitor; and antiparkinsonism drugs

28. What is pronator drift
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
IVIG and plasmapheresis
Not within 24 hours; give afte 24-48 hours if patient stable
Myasthenia; due to autoantibodies against acetylecholine receptor;

29. patient with hx of cluster headache p/w retroorbital pain lacrimation - vomiting suddenly
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Deficit in cranial nerve function
Upright supine position

30. prodrome of vasovagal syncope
Upright supine position
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Tunnel vision - diaphoresis - nausea - pallor
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

31. hx of epilepsy - now unresponsive - slight twhiching of mouth and arms
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Diabetes insipidus
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin

32. differentiate lewy body dementia and vascular dementia
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
Taper gradually to prevent seizure relapse
Lesion in nondominant temporal lobe
82% specific for dementia

33. alcoholic p/w confusion - ataxia - tremor - nystamgus

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34. 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;
Cerebral palsy; dx mri
Obturator n lesion
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48

35. drags leg forward in every steps - no knee flexion; hip flexion and straight legs
Obturator n lesion
Aphasia - neglect - agnosia - acalculia etc
Spastic paraparesis
Verapamil

36. contraindication of sumatripta
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Diabetes insipidus
Coronary artery disease
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised

37. walking like drunken sailor; jerky hesitant and walks in zigzag pattern
It patient has electrolyte imbalance and hypothermia
Nystagmus on far lateral gaze
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Cerebellar lesion

38. impaired hepatic conjugation of billirubin
Myasthenia; due to autoantibodies against acetylecholine receptor;
Not within 24 hours; give afte 24-48 hours if patient stable
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Gilberts disease

39. What mmse score suggest dementia
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
<20; if patient scores >25 benign forgetfulness
Despite the term neuroma they arise from schwann cells - schwanoma
Follows viral illness; vertigo - tinnitus - nausea. self limiting

40. headache - non reactive pupil - fall on both sides during walking - impaired upward gaze
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Verapamil
Aspirin - control HTN and swallow eval before giving any oral meds
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty

41. 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
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.
Cholinesterase inhibitor; and antiparkinsonism drugs
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure

42. How to diffrentiate tick borne paralysis from GBS and spinal cord tumor
Construction apraxia; lesion in non dominant parietal lobe (right)
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.
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Corticosteroid and acyclovir

43. women with unilateral eye pain; neurlogic symptoms here there at different times
Not within 24 hours; give afte 24-48 hours if patient stable
Femoral n lesion
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS

44. What bp med to be given in a patient with high bp and signs of opioid withdrawal
Vitamin B12 deficiency
It patient has electrolyte imbalance and hypothermia
Clonidine will take care both high bp and withdrawal
Verapamil

45. When to use dopamine agonist pramipexol in parkinson
Cerebral palsy; dx mri
Distal lower motor neuron disease
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Cerebellar lesion

46. differentiate wenicke and korsakoff
It patient has electrolyte imbalance and hypothermia
Clonidine will take care both high bp and withdrawal
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
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

47. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
Clonidine will take care both high bp and withdrawal
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Not within 24 hours; give afte 24-48 hours if patient stable
Cerebral palsy; dx mri

48. medial thigh sensory loss and weakness in addcution
Lesion in nondominant temporal lobe
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Obturator n lesion
High dose IV methyleprednisone;

49. Acute onset of left arm weakness
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Cholinesterase inhibitor; and antiparkinsonism drugs
Upright supine position

50. dominant parietal lobe on the left side
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
RBC count >6000
90% of right handed and 60% of left handed persons; speech and language function
Not within 24 hours; give afte 24-48 hours if patient stable