Test your basic knowledge |

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. Tx of bells palsy
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Corticosteroid and acyclovir
Obturator n lesion
Distal lower motor neuron disease

2. get up and go test
RBC count >6000
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Get up from chair walk a short distance turn around and sit; screening test for fall
Cholinesterase inhibitor; and antiparkinsonism drugs

3. cluster headache
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
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
Upright supine position

4. women with unilateral eye pain; neurlogic symptoms here there at different times
82% specific for dementia
Normal pressure hydrocephalus
RBC count >6000
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS

5. phenytoin and OCP
Cerebellar lesion
<20; if patient scores >25 benign forgetfulness
Reduced efficacy of OCP
Lesion in nondominant temporal lobe

6. When to use dopamine agonist pramipexol in parkinson
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Corticosteroid and acyclovir
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
EPV - campylobacter - HSV

7. brain stem lesion
Acetylecholinersterase inhibitors
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
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Deficit in cranial nerve function

8. How to diffrentiate tick borne paralysis from GBS and spinal cord tumor
Gilberts disease
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Reduced efficacy of OCP
Aspirin - control HTN and swallow eval before giving any oral meds

9. walking like drunken sailor; jerky hesitant and walks in zigzag pattern
Coronary artery disease
Cerebellar lesion
EPV - campylobacter - HSV
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening

10. Acute onset of left arm weakness
Nystagmus on far lateral gaze
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica

11. How to confirm braindeath?
Cholinesterase inhibitor; and antiparkinsonism drugs
Obturator n lesion
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.
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure

12. How to tx lewy body dementia
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
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;
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Cholinesterase inhibitor; and antiparkinsonism drugs

13. botulism
Antitoxin
Corticosteroid and acyclovir
Autospy gold standard
Myasthenia; due to autoantibodies against acetylecholine receptor;

14. 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

15. What mmse score suggest dementia
Cerebral palsy; dx mri
90% of right handed and 60% of left handed persons; speech and language function
<20; if patient scores >25 benign forgetfulness
Difficulty in writing - calculating - distinguishing left and write

16. How to differentiate botulism from tick born paralysis - GBS and MG
IVIG and plasmapheresis
Botulism has descending paralysis in contrast othere have ascending paralysis
Taper gradually to prevent seizure relapse
Cholinesterase inhibitor; and antiparkinsonism drugs

17. 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
Cerebral palsy; dx mri
20%
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised

18. korsafoff psychosis
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
MS
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;
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement

19. How to tx stroke patient came after 6h
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Verapamil
Aspirin - control HTN and swallow eval before giving any oral meds
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised

20. cortical lesion
Botulism has descending paralysis in contrast othere have ascending paralysis
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.
Construction apraxia; lesion in non dominant parietal lobe (right)
Aphasia - neglect - agnosia - acalculia etc

21. How to differentiate traumatic LP and SAH
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
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.
Vitamin B12 deficiency

22. How to perform apnea test
Aphasia - neglect - agnosia - acalculia etc
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
Botulism has descending paralysis in contrast othere have ascending paralysis

23. excessive elevation of legs during walking (toe touch floor earlier than heels)
Distal lower motor neuron disease
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
Tunnel vision - diaphoresis - nausea - pallor
Follows viral illness; vertigo - tinnitus - nausea. self limiting

24. dementia plus urinary incontinence
Upright supine position
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Normal pressure hydrocephalus
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

25. Patient with carbamazepine; What should be advice?
Nystagmus on far lateral gaze
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;
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then 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

26. double vision at the end of day and ptosis
Aphasia - neglect - agnosia - acalculia etc
Upright supine position
Spastic paraparesis
Myasthenia; due to autoantibodies against acetylecholine receptor;

27. anerior and anteriomedial thigh paresthesia - decreased DTR
Despite the term neuroma they arise from schwann cells - schwanoma
Femoral n lesion
RBC count >6000
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

28. differentiate wenicke and korsakoff
Femoral n lesion
Vitamin B12 deficiency
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
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

29. When to start fibrinolytic therapy in stroke patient?
Coronary artery disease
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
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
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure

30. headache - non reactive pupil - fall on both sides during walking - impaired upward gaze
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Corticosteroid and acyclovir
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
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

31. 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
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
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement

32. What is pronator drift
Tunnel vision - diaphoresis - nausea - pallor
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
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure

33. GBS
High dose IV methyleprednisone;
Cerebellar lesion
Difficulty in writing - calculating - distinguishing left and write
IVIG and plasmapheresis

34. MG
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Acetylecholinersterase inhibitors
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Normal pressure hydrocephalus

35. labyrinthitis
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Normal pressure hydrocephalus
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Cerebral palsy; dx mri

36. When to suspect traumatic LP
Reduced efficacy of OCP
Myasthenia; due to autoantibodies against acetylecholine receptor;
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
RBC count >6000

37. How to differentiate medial and lateral pontine syndrome
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Cerebellar lesion
Corticosteroid and acyclovir
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

38. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
Entacapone - COMT inhibitor
Myasthenia; due to autoantibodies against acetylecholine receptor;
Cerebral palsy; dx mri
Nystagmus on far lateral gaze

39. benign essential tremor
Propranolol or primidone
MS
High dose IV methyleprednisone;
Get up from chair walk a short distance turn around and sit; screening test for fall

40. How to prevent prevent frequency of MS exacerbation
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Vitamin B12 deficiency
Clonidine will take care both high bp and withdrawal

41. What is can be used cluster headache prevention
Antitoxin
Nystagmus on far lateral gaze
Verapamil
Follows viral illness; vertigo - tinnitus - nausea. self limiting

42. Tx of GBS
Get up from chair walk a short distance turn around and sit; screening test for fall
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID

43. hx of epilepsy - now unresponsive - slight twhiching of mouth and arms
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
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
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48

44. Why V12 deficient develop hypokalemia after tx with b12
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Cerebral palsy; dx mri
82% specific for dementia
Diabetes insipidus

45. What bp med to be given in a patient with high bp and signs of opioid withdrawal
Clonidine will take care both high bp and withdrawal
Verapamil
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.
Cerebral palsy; dx mri

46. impaired vibration and increased DTR
Vitamin B12 deficiency
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Autospy gold standard
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.

47. 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
Obturator n lesion
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
82% specific for dementia

48. prodrome of vasovagal syncope
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Deficit in cranial nerve function
Tunnel vision - diaphoresis - nausea - pallor
90% of right handed and 60% of left handed persons; speech and language function

49. How to tx acute exacerbation of MS
Follows viral illness; vertigo - tinnitus - nausea. self limiting
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Wernicke's encephalopathy; due to thiamine definition; medical emergency
High dose IV methyleprednisone;

50. How to differentiate dementias
MS
RBC count >6000
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l