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Test your basic knowledge |
USMLE Step3 Neurology
Start Test
Study First
Subjects
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health-sciences
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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. How to diffrentiate tick borne paralysis from GBS and spinal cord tumor
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
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Construction apraxia; lesion in non dominant parietal lobe (right)
2. best diagnosis for parkinsonim
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
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
Autospy gold standard
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
3. How to differentiate parkinson and benign essential tremor
IVIG and plasmapheresis
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
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
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. How to tx lewy body dementia
Cholinesterase inhibitor; and antiparkinsonism drugs
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Verapamil
5. korsafoff psychosis
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 glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Spastic paraparesis
6. prodrome of vasovagal syncope
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
Verapamil
Tunnel vision - diaphoresis - nausea - pallor
It patient has electrolyte imbalance and hypothermia
7. what drug is used to extend effects of levodopa
Difficulty in writing - calculating - distinguishing left and write
Entacapone - COMT inhibitor
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
8. When to use dopamine agonist pramipexol in parkinson
Cerebral palsy; dx mri
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
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;
Despite the term neuroma they arise from schwann cells - schwanoma
9. impaired hepatic conjugation of billirubin
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Gilberts disease
Acetylecholinersterase inhibitors
10. What is can be used cluster headache prevention
Acetylecholinersterase inhibitors
Coronary artery disease
Verapamil
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
11. contraindication of sumatripta
Coronary artery disease
Despite the term neuroma they arise from schwann cells - schwanoma
High dose IV methyleprednisone;
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
12. medial thigh sensory loss and weakness in addcution
20%
Autospy gold standard
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Obturator n lesion
13. how donepezil - acetylecholinsterase inhibitor works in Alzheimers
<20; if patient scores >25 benign forgetfulness
Normal pressure hydrocephalus
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
14. get up and go test
Vitamin B12 deficiency
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Corticosteroid and acyclovir
Get up from chair walk a short distance turn around and sit; screening test for fall
15. How to prevent prevent frequency of MS exacerbation
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
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
EPV - campylobacter - HSV
16. patient with hx of cluster headache p/w retroorbital pain lacrimation - vomiting suddenly
MS
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
Distal lower motor neuron disease
17. What mmse score suggest dementia
Cholinesterase inhibitor; and antiparkinsonism drugs
Cerebellar lesion
<20; if patient scores >25 benign forgetfulness
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
18. Patient with carbamazepine; What should be advice?
Entacapone - COMT inhibitor
Construction apraxia; lesion in non dominant parietal lobe (right)
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
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
19. 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
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Entacapone - COMT inhibitor
EPV - campylobacter - HSV
20. construction worker works in squatting position; now develop decreased sensation over anterolateral thigh
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
EPV - campylobacter - HSV
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
21. indication of plasmapheresis in GBS
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
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
Cholinesterase inhibitor; and antiparkinsonism drugs
22. Tx of GBS
Difficulty in writing - calculating - distinguishing left and write
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;
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
23. dementia plus urinary incontinence
Not within 24 hours; give afte 24-48 hours if patient stable
Despite the term neuroma they arise from schwann cells - schwanoma
Normal pressure hydrocephalus
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;
24. How to stop antiepileptic drugs
Clonidine will take care both high bp and withdrawal
<20; if patient scores >25 benign forgetfulness
Taper gradually to prevent seizure relapse
Aspirin - control HTN and swallow eval before giving any oral meds
25. dominant parietal lobe on the left side
90% of right handed and 60% of left handed persons; speech and language function
Spastic paraparesis
Cholinesterase inhibitor; and antiparkinsonism drugs
Reduced efficacy of OCP
26. How to differentiate traumatic LP and SAH
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
27. What bp med to be given in a patient with high bp and signs of opioid withdrawal
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Clonidine will take care both high bp and withdrawal
Vitamin B12 deficiency
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
28. women with unilateral eye pain; neurlogic symptoms here there at different times
90% of right handed and 60% of left handed persons; speech and language function
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
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
29. brain stem lesion
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
Antitoxin
Deficit in cranial nerve function
Tunnel vision - diaphoresis - nausea - pallor
30. at first tingling in toes and feet then weakness in extremities
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
IVIG and plasmapheresis
31. When to use brain spect scintigraphy to confirm brain death
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
High dose IV methyleprednisone;
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
It patient has electrolyte imbalance and hypothermia
32. What percent of dementia is reversible
20%
Corticosteroid and acyclovir
Reduced efficacy of OCP
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
33. lesion in dominant parietal lobe
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
Difficulty in writing - calculating - distinguishing left and write
20%
Wernicke's encephalopathy; due to thiamine definition; medical emergency
34. Tx of bells palsy
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Corticosteroid and acyclovir
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
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
35. How to tx acute exacerbation of MS
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
High dose IV methyleprednisone;
20%
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
36. How to confirm braindeath?
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.
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Nystagmus on far lateral gaze
Normal pressure hydrocephalus
37. benign essential tremor
Propranolol or primidone
Verapamil
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Spastic paraparesis
38. How to tx stroke patient came after 6h
RBC count >6000
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Aspirin - control HTN and swallow eval before giving any oral meds
Autospy gold standard
39. What is pronator drift
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
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;
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
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
40. Unable to copy of matchstick - unable to dress up
Verapamil
Normal pressure hydrocephalus
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Construction apraxia; lesion in non dominant parietal lobe (right)
41. How to manage stroke patient came within 4 hours
High dose IV methyleprednisone;
Spastic paraparesis
Upright supine position
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
42. labyrinthitis
Coronary artery disease
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Antitoxin
20%
43. How to differentiate dementias
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Get up from chair walk a short distance turn around and sit; screening test for fall
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
44. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
Cerebral palsy; dx mri
Vitamin B12 deficiency
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Cholinesterase inhibitor; and antiparkinsonism drugs
45. How to perform apnea test
Clonidine will take care both high bp and withdrawal
High dose IV methyleprednisone;
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
46. Most effective to reduce aspiration in stroke or patient with swallowing dysfunction
Antitoxin
Upright supine position
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
82% specific for dementia
47. When headache is presenting complaint of brain tumor
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
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Reduced efficacy of OCP
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
48. botulism
Verapamil
Antitoxin
Cerebral palsy; dx mri
Acetylecholinersterase inhibitors
49. MMSE score of less than 24
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
82% specific for dementia
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
50. How to differentiate medial and lateral medullary syndrome
Lesion in nondominant temporal lobe
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;
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
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