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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. construction worker works in squatting position; now develop decreased sensation over anterolateral thigh
Deficit in cranial nerve function
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Propranolol or primidone

2. excessive elevation of legs during walking (toe touch floor earlier than heels)
Spastic paraparesis
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
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
Distal lower motor neuron disease

3. get up and go test
Clonidine will take care both high bp and withdrawal
Aphasia - neglect - agnosia - acalculia etc
Normal pressure hydrocephalus
Get up from chair walk a short distance turn around and sit; screening test for fall

4. drags leg forward in every steps - no knee flexion; hip flexion and straight legs
Diabetes insipidus
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
Spastic paraparesis
It patient has electrolyte imbalance and hypothermia

5. What percent of dementia is reversible
IVIG and plasmapheresis
Obturator n lesion
Normal pressure hydrocephalus
20%

6. medial thigh sensory loss and weakness in addcution
Acetylecholinersterase inhibitors
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Obturator n lesion
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. Should we tx htn in acute ischemic stroke

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8. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Acetylecholinersterase inhibitors
Cerebral palsy; dx mri
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

9. When headache is presenting complaint of brain tumor
Not within 24 hours; give afte 24-48 hours if patient stable
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
RBC count >6000
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l

10. How to stop antiepileptic drugs
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Taper gradually to prevent seizure relapse
Wernicke's encephalopathy; due to thiamine definition; medical emergency

11. When to give aspirin when patient on tPA after stroke
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Deficit in cranial nerve function
Not within 24 hours; give afte 24-48 hours if patient stable

12. phenytoin and OCP
Reduced efficacy of OCP
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
MS
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. How to prevent prevent frequency of MS exacerbation
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
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
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner

14. korsafoff psychosis
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
Acetylecholinersterase inhibitors
Corticosteroid and acyclovir

15. impaired vibration and increased DTR
Cerebral palsy; dx mri
Vitamin B12 deficiency
Upright supine position
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa

16. oligoclonal band in CSF
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Follows viral illness; vertigo - tinnitus - nausea. self limiting
MS
EPV - campylobacter - HSV

17. dominant parietal lobe on the left side
Cerebral palsy; dx mri
Propranolol or primidone
RBC count >6000
90% of right handed and 60% of left handed persons; speech and language function

18. double vision at the end of day and ptosis
Upright supine position
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Corticosteroid and acyclovir
Myasthenia; due to autoantibodies against acetylecholine receptor;

19. prodrome of vasovagal syncope
Reduced efficacy of OCP
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Tunnel vision - diaphoresis - nausea - pallor
Difficulty in writing - calculating - distinguishing left and write

20. How to tx lewy body dementia
Despite the term neuroma they arise from schwann cells - schwanoma
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Cholinesterase inhibitor; and antiparkinsonism drugs
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS

21. Most effective to reduce aspiration in stroke or patient with swallowing dysfunction
Taper gradually to prevent seizure relapse
Upright supine position
Cholinesterase inhibitor; and antiparkinsonism drugs
IVIG and plasmapheresis

22. benign essential tremor
Verapamil
Cerebellar lesion
MS
Propranolol or primidone

23. indication of plasmapheresis in GBS
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
Clonidine will take care both high bp and withdrawal
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure

24. How to tx stroke patient came after 6h
Aspirin - control HTN and swallow eval before giving any oral meds
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
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Distal lower motor neuron disease

25. stroke with lower facial palsy - pronator drift despite on aspirin
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
EPV - campylobacter - HSV
90% of right handed and 60% of left handed persons; speech and language function
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy

26. lesion in dominant tempora lobe
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Aphasia - neglect - agnosia - acalculia etc
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Coronary artery disease

27. Patient with carbamazepine; What should be advice?
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
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
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
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

28. labyrinthitis
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Aphasia - neglect - agnosia - acalculia etc
Cerebellar lesion

29. What bp med to be given in a patient with high bp and signs of opioid withdrawal
<20; if patient scores >25 benign forgetfulness
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Clonidine will take care both high bp and withdrawal

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

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31. brain stem lesion
Diabetes insipidus
Deficit in cranial nerve function
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;

32. lesion in dominant parietal lobe
Difficulty in writing - calculating - distinguishing left and write
Vitamin B12 deficiency
Taper gradually to prevent seizure relapse
Nystagmus on far lateral gaze

33. cortical lesion
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Aphasia - neglect - agnosia - acalculia etc
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
High dose IV methyleprednisone;

34. women with unilateral eye pain; neurlogic symptoms here there at different times
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
EPV - campylobacter - HSV
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Spastic paraparesis

35. impaired perception of complex sounds
Despite the term neuroma they arise from schwann cells - schwanoma
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Lesion in nondominant temporal lobe
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel

36. When to start fibrinolytic therapy in stroke patient?
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test

37. Blood transfusion in hypothermia
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
High dose IV methyleprednisone;
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Obturator n lesion

38. When to use dopamine agonist pramipexol in parkinson
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Acetylecholinersterase inhibitors
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Wernicke's encephalopathy; due to thiamine definition; medical emergency

39. cluster headache
Spastic paraparesis
90% of right handed and 60% of left handed persons; speech and language function
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
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

40. craniopharyngioma
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
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
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Diabetes insipidus

41. botulism
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Antitoxin
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Autospy gold standard

42. 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
Myasthenia; due to autoantibodies against acetylecholine receptor;
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Deficit in cranial nerve function

43. How to diffrentiate tick borne paralysis from GBS and spinal cord tumor
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
Difficulty in writing - calculating - distinguishing left and write
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Cerebral palsy; dx mri

44. When to suspect traumatic LP
RBC count >6000
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Cerebellar lesion
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge

45. headache - non reactive pupil - fall on both sides during walking - impaired upward gaze
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
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
Get up from chair walk a short distance turn around and sit; screening test for fall

46. How to confirm braindeath?
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then 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.
Entacapone - COMT inhibitor
Botulism has descending paralysis in contrast othere have ascending paralysis

47. How to differentiate medial and lateral pontine syndrome
Diabetes insipidus
Obturator n lesion
Coronary artery disease
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

48. How to manage stroke patient came within 4 hours
Gilberts disease
Acetylecholinersterase inhibitors
Get up from chair walk a short distance turn around and sit; screening test for fall
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;

49. best diagnosis for parkinsonim
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
MS
Autospy gold standard
Wernicke's encephalopathy; due to thiamine definition; medical emergency

50. What is can be used cluster headache prevention
Verapamil
Get up from chair walk a short distance turn around and sit; screening test for fall
Spastic paraparesis
Diabetes insipidus