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USMLE Step3 Neurology

Subjects : health-sciences, usmle-step-3

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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. differentiate lewy body dementia and vascular dementia
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
Antitoxin
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
Despite the term neuroma they arise from schwann cells - schwanoma

2. excessive elevation of legs during walking (toe touch floor earlier than heels)
RBC count >6000
Distal lower motor neuron disease
Cholinesterase inhibitor; and antiparkinsonism drugs
<20; if patient scores >25 benign forgetfulness

3. How to differentiate medial and lateral pontine syndrome
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
20%
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
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

4. impaired vibration and increased DTR
Get up from chair walk a short distance turn around and sit; screening test for fall
EPV - campylobacter - HSV
Vitamin B12 deficiency
Upright supine position

5. how donepezil - acetylecholinsterase inhibitor works in Alzheimers
Botulism has descending paralysis in contrast othere have ascending paralysis
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
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Deficit in cranial nerve function

6. Blood transfusion in hypothermia
Myasthenia; due to autoantibodies against acetylecholine receptor;
Lesion in nondominant temporal lobe
Tunnel vision - diaphoresis - nausea - pallor
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate

7. double vision at the end of day and ptosis
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;
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
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

8. Why V12 deficient develop hypokalemia after tx with b12
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;
Aphasia - neglect - agnosia - acalculia etc
Reduced efficacy of OCP
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48

9. dementia plus urinary incontinence
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Normal pressure hydrocephalus
Gilberts disease

10. GBS
High dose IV methyleprednisone;
Coronary artery disease
Normal pressure hydrocephalus
IVIG and plasmapheresis

11. Tx of GBS
Taper gradually to prevent seizure relapse
Cholinesterase inhibitor; and antiparkinsonism drugs
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
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure

12. Most effective to reduce aspiration in stroke or patient with swallowing dysfunction
Upright supine position
MS
Despite the term neuroma they arise from schwann cells - schwanoma
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure

13. best diagnosis for parkinsonim
It patient has electrolyte imbalance and hypothermia
Spastic paraparesis
Autospy gold standard
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;

14. How to prevent prevent frequency of MS exacerbation
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Aspirin - control HTN and swallow eval before giving any oral meds
Femoral n lesion

15. get up and go test
Propranolol or primidone
<20; if patient scores >25 benign forgetfulness
Get up from chair walk a short distance turn around and sit; screening test for fall
Aphasia - neglect - agnosia - acalculia etc

16. How to differentiate traumatic LP and SAH
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure

17. medial thigh sensory loss and weakness in addcution
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Aspirin - control HTN and swallow eval before giving any oral meds
Deficit in cranial nerve function
Obturator n lesion

18. craniopharyngioma
Not within 24 hours; give afte 24-48 hours if patient stable
Follows viral illness; vertigo - tinnitus - nausea. self limiting
RBC count >6000
Diabetes insipidus

19. anerior and anteriomedial thigh paresthesia - decreased DTR
Propranolol or primidone
Femoral n lesion
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

20. walking like drunken sailor; jerky hesitant and walks in zigzag pattern
Autospy gold standard
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Cerebellar lesion
It patient has electrolyte imbalance and hypothermia

21. labyrinthitis
Gilberts disease
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
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

22. What is can be used cluster headache prevention
Get up from chair walk a short distance turn around and sit; screening test for fall
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Verapamil
Cholinesterase inhibitor; and antiparkinsonism drugs

23. botulism
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
Propranolol or primidone
90% of right handed and 60% of left handed persons; speech and language function
Antitoxin

24. How to tx stroke patient came after 6h
Entacapone - COMT inhibitor
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Aspirin - control HTN and swallow eval before giving any oral meds

25. what drug is used to extend effects of levodopa
Entacapone - COMT inhibitor
Lesion in nondominant temporal lobe
Taper gradually to prevent seizure relapse
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID

26. impaired hepatic conjugation of billirubin
Not within 24 hours; give afte 24-48 hours if patient stable
Acetylecholinersterase inhibitors
90% of right handed and 60% of left handed persons; speech and language function
Gilberts disease

27. Should we tx htn in acute ischemic stroke

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28. phenytoin and OCP
Reduced efficacy of OCP
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Coronary artery disease

29. cortical lesion
Aphasia - neglect - agnosia - acalculia etc
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Obturator n lesion

30. construction worker works in squatting position; now develop decreased sensation over anterolateral thigh
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Upright supine position
Deficit in cranial nerve function

31. benign essential tremor
MS
Propranolol or primidone
Distal lower motor neuron disease
Tunnel vision - diaphoresis - nausea - pallor

32. How to stop antiepileptic drugs
It patient has electrolyte imbalance and hypothermia
Despite the term neuroma they arise from schwann cells - schwanoma
Spastic paraparesis
Taper gradually to prevent seizure relapse

33. impaired perception of complex sounds
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
Lesion in nondominant temporal lobe
Myasthenia; due to autoantibodies against acetylecholine receptor;
Gilberts disease

34. differentiate picks and huntington
82% specific for dementia
Cerebral palsy; dx mri
Construction apraxia; lesion in non dominant parietal lobe (right)
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

35. at first tingling in toes and feet then weakness in extremities
Spastic paraparesis
Upright supine position
Not within 24 hours; give afte 24-48 hours if patient stable
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure

36. Patient with carbamazepine; What should be advice?
Acetylecholinersterase inhibitors
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
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

37. women with unilateral eye pain; neurlogic symptoms here there at different times
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
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
Gilberts disease

38. Unable to copy of matchstick - unable to dress up
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Construction apraxia; lesion in non dominant parietal lobe (right)
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Tunnel vision - diaphoresis - nausea - pallor

39. When to start fibrinolytic therapy in stroke patient?
90% of right handed and 60% of left handed persons; speech and language function
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Femoral n lesion

40. korsafoff psychosis
Cerebral palsy; dx mri
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
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
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement

41. How to differentiate parkinson and benign essential tremor
Myasthenia; due to autoantibodies against acetylecholine receptor;
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
Follows viral illness; vertigo - tinnitus - nausea. self limiting
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.

42. What bp med to be given in a patient with high bp and signs of opioid withdrawal
Deficit in cranial nerve function
Clonidine will take care both high bp and withdrawal
<20; if patient scores >25 benign forgetfulness
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin

43. When headache is presenting complaint of brain tumor
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Autospy gold standard
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

44. stroke with lower facial palsy - pronator drift despite on aspirin
Botulism has descending paralysis in contrast othere have ascending paralysis
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Diabetes insipidus

45. How to tx acute exacerbation of MS
Clonidine will take care both high bp and withdrawal
Lesion in nondominant temporal lobe
Propranolol or primidone
High dose IV methyleprednisone;

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

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47. MMSE score of less than 24
MS
Cerebellar lesion
82% specific for dementia
Nystagmus on far lateral gaze

48. When to use brain spect scintigraphy to confirm brain death
Construction apraxia; lesion in non dominant parietal lobe (right)
It patient has electrolyte imbalance and hypothermia
Antitoxin
Difficulty in writing - calculating - distinguishing left and write

49. infections in GBS
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
90% of right handed and 60% of left handed persons; speech and language function
EPV - campylobacter - HSV
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH

50. How to confirm braindeath?
Coronary artery disease
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.
Spastic paraparesis

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USMLE Step3 Neurology

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