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. When to use brain spect scintigraphy to confirm brain death
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Obturator n lesion
It patient has electrolyte imbalance and hypothermia

2. impaired perception of complex sounds
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Lesion in nondominant temporal lobe
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement

3. How to differentiate parkinson and benign essential tremor
Despite the term neuroma they arise from schwann cells - schwanoma
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
Autospy gold standard

4. What is can be used cluster headache prevention
It patient has electrolyte imbalance and hypothermia
Diabetes insipidus
Entacapone - COMT inhibitor
Verapamil

5. prodrome of vasovagal syncope
Tunnel vision - diaphoresis - nausea - pallor
Gilberts disease
Clonidine will take care both high bp and withdrawal
MS

6. Tx of GBS
Cerebral palsy; dx mri
Autospy gold standard
Spontaneous remission; admit if suspected and monitor pulse ox for 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;

7. construction worker works in squatting position; now develop decreased sensation over anterolateral thigh
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
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Lesion in nondominant temporal lobe
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica

8. When headache is presenting complaint of brain tumor
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
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
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA

9. What mmse score suggest dementia
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
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.
Aphasia - neglect - agnosia - acalculia etc
<20; if patient scores >25 benign forgetfulness

10. cluster headache
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
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
Antitoxin

11. excessive elevation of legs during walking (toe touch floor earlier than heels)
Distal lower motor neuron disease
Despite the term neuroma they arise from schwann cells - schwanoma
Aphasia - neglect - agnosia - acalculia etc
82% specific for dementia

12. Patient with carbamazepine; What should be advice?
IVIG and plasmapheresis
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%
Propranolol or primidone

13. Unable to copy of matchstick - unable to dress up
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Aspirin - control HTN and swallow eval before giving any oral meds
Construction apraxia; lesion in non dominant parietal lobe (right)
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement

14. Tx of bells palsy
Propranolol or primidone
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
It patient has electrolyte imbalance and hypothermia

15. severe headache and high BP
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Nystagmus on far lateral gaze
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy

16. walking like drunken sailor; jerky hesitant and walks in zigzag pattern
Cerebellar lesion
Myasthenia; due to autoantibodies against acetylecholine receptor;
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l

17. anerior and anteriomedial thigh paresthesia - decreased DTR
Femoral n lesion
IVIG and plasmapheresis
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure

18. how donepezil - acetylecholinsterase inhibitor works in Alzheimers
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Nystagmus on far lateral gaze
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

19. korsafoff psychosis
Autospy gold standard
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
Nystagmus on far lateral gaze
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. How to differentiate medial and lateral pontine syndrome
Distal lower motor neuron disease
IVIG and plasmapheresis
Despite the term neuroma they arise from schwann cells - schwanoma
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

21. When to suspect traumatic LP
RBC count >6000
Not within 24 hours; give afte 24-48 hours if patient stable
Diabetes insipidus
Upright supine position

22. labyrinthitis
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Distal lower motor neuron disease
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID

23. differentiate wenicke and korsakoff
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
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
RBC count >6000
Construction apraxia; lesion in non dominant parietal lobe (right)

24. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
Cerebral palsy; dx mri
82% specific for 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
RBC count >6000

25. How to manage stroke patient came within 4 hours
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Acetylecholinersterase inhibitors
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;

26. How to perform apnea test
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
High dose IV methyleprednisone;
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure

27. hx of epilepsy - now unresponsive - slight twhiching of mouth and arms
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Distal lower motor neuron disease
Antitoxin
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin

28. 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;
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge

29. What percent of dementia is reversible
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Aphasia - neglect - agnosia - acalculia etc
20%
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure

30. How to tx acute exacerbation of MS
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Spastic paraparesis
High dose IV methyleprednisone;

31. How to prevent prevent frequency of MS exacerbation
Antitoxin
EPV - campylobacter - HSV
Clonidine will take care both high bp and withdrawal
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised

32. benign essential tremor
Follows viral illness; vertigo - tinnitus - nausea. self limiting
90% of right handed and 60% of left handed persons; speech and language function
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;
Propranolol or primidone

33. impaired hepatic conjugation of billirubin
Difficulty in writing - calculating - distinguishing left and write
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
<20; if patient scores >25 benign forgetfulness
Gilberts disease

34. Should we tx htn in acute ischemic stroke

35. How to diffrentiate tick borne paralysis from GBS and spinal cord tumor
Entacapone - COMT inhibitor
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
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

36. MG
Normal pressure hydrocephalus
Acetylecholinersterase inhibitors
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
MS

37. what drug is used to extend effects of levodopa
Clonidine will take care both high bp and withdrawal
Not within 24 hours; give afte 24-48 hours if patient stable
Entacapone - COMT inhibitor
It patient has electrolyte imbalance and hypothermia

38. GBS
IVIG and plasmapheresis
<20; if patient scores >25 benign forgetfulness
Despite the term neuroma they arise from schwann cells - schwanoma
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty

39. dementia plus urinary incontinence
Verapamil
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
Normal pressure hydrocephalus
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty

40. dominant parietal lobe on the left side
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
20%
90% of right handed and 60% of left handed persons; speech and language function

41. MMSE score of less than 24
Upright supine position
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
Autospy gold standard
82% specific for dementia

42. drags leg forward in every steps - no knee flexion; hip flexion and straight legs
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
Botulism has descending paralysis in contrast othere have ascending paralysis
Spastic paraparesis

43. headache - non reactive pupil - fall on both sides during walking - impaired upward gaze
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Despite the term neuroma they arise from schwann cells - schwanoma
Coronary artery disease
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica

44. infections in GBS
Entacapone - COMT inhibitor
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
EPV - campylobacter - HSV
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;

45. How to tx lewy body dementia
Wernicke's encephalopathy; due to thiamine definition; medical emergency
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
Gilberts disease

46. double vision at the end of day and ptosis
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
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
Nystagmus on far lateral gaze
Myasthenia; due to autoantibodies against acetylecholine receptor;

47. indication of plasmapheresis in GBS
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Taper gradually to prevent seizure relapse
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate

48. Blood transfusion in hypothermia
Not within 24 hours; give afte 24-48 hours if patient stable
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Gilberts disease
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate

49. patient with hx of cluster headache p/w retroorbital pain lacrimation - vomiting suddenly
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
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
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.
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID

50. lesion in dominant tempora lobe
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Myasthenia; due to autoantibodies against acetylecholine receptor;
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal