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. severe headache and high BP
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Lesion in nondominant temporal lobe
Spastic paraparesis
Construction apraxia; lesion in non dominant parietal lobe (right)

2. oligoclonal band in CSF
MS
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Get up from chair walk a short distance turn around and sit; screening test for fall
Reduced efficacy of OCP

3. lesion in dominant parietal lobe
Difficulty in writing - calculating - distinguishing left and write
Reduced efficacy of OCP
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Diabetes insipidus

4. How to differentiate parkinson and benign essential tremor
EPV - campylobacter - HSV
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Follows viral illness; vertigo - tinnitus - nausea. self limiting
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

5. what drug is used to extend effects of 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
Entacapone - COMT inhibitor
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

6. Why V12 deficient develop hypokalemia after tx with b12
Femoral n lesion
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
EPV - campylobacter - HSV

7. Tx of bells palsy
Spastic paraparesis
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Difficulty in writing - calculating - distinguishing left and write
Corticosteroid and acyclovir

8. get up and go test
Get up from chair walk a short distance turn around and sit; screening test for fall
Nystagmus on far lateral gaze
Aphasia - neglect - agnosia - acalculia etc
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.

9. excessive elevation of legs during walking (toe touch floor earlier than heels)
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Normal pressure hydrocephalus
Distal lower motor neuron disease

10. phenytoin and OCP
Reduced efficacy of OCP
Propranolol or primidone
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
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

11. What percent of dementia is reversible
MS
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
20%
Difficulty in writing - calculating - distinguishing left and write

12. stroke with lower facial palsy - pronator drift despite on aspirin
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
MS
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica

13. 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
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
RBC count >6000

14. construction worker works in squatting position; now develop decreased sensation over anterolateral thigh
Cerebellar lesion
Gilberts disease
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
MS

15. Unable to copy of matchstick - unable to dress up
Vitamin B12 deficiency
20%
Construction apraxia; lesion in non dominant parietal lobe (right)
RBC count >6000

16. Patient with carbamazepine; What should be advice?
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
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test

17. When to use brain spect scintigraphy to confirm brain death
Obturator n lesion
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Not within 24 hours; give afte 24-48 hours if patient stable
It patient has electrolyte imbalance and hypothermia

18. How to tx stroke patient came after 6h
Corticosteroid and acyclovir
Aspirin - control HTN and swallow eval before giving any oral meds
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Clonidine will take care both high bp and withdrawal

19. How to stop antiepileptic drugs
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Taper gradually to prevent seizure relapse
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Cholinesterase inhibitor; and antiparkinsonism drugs

20. contraindication of sumatripta
Deficit in cranial nerve function
Cerebellar lesion
Coronary artery disease
RBC count >6000

21. differentiate lewy body dementia and vascular dementia
Vitamin B12 deficiency
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%
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

22. craniopharyngioma
Diabetes insipidus
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Taper gradually to prevent seizure relapse
Normal pressure hydrocephalus

23. How to differentiate medial and lateral pontine syndrome
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
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
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa

24. korsafoff psychosis
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Reduced efficacy of OCP
Cerebral palsy; dx mri

25. dominant parietal lobe on the left side
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
90% of right handed and 60% of left handed persons; speech and language function
Antitoxin
Cerebellar lesion

26. best diagnosis for parkinsonim
Botulism has descending paralysis in contrast othere have ascending paralysis
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
Autospy gold standard
Taper gradually to prevent seizure relapse

27. patient with hx of cluster headache p/w retroorbital pain lacrimation - vomiting suddenly
Antitoxin
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
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS

28. What bp med to be given in a patient with high bp and signs of opioid withdrawal
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Clonidine will take care both high bp and withdrawal
IVIG and plasmapheresis
Reduced efficacy of OCP

29. Most effective to reduce aspiration in stroke or patient with swallowing dysfunction
Upright supine position
90% of right handed and 60% of left handed persons; speech and language function
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.
Propranolol or primidone

30. botulism
Antitoxin
Propranolol or primidone
Vitamin B12 deficiency
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate

31. earliest sign of phenytoin toxicity
Nystagmus on far lateral gaze
High dose IV methyleprednisone;
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
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

32. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
Diabetes insipidus
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Cerebral palsy; dx mri
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner

33. infections in GBS
Vitamin B12 deficiency
High dose IV methyleprednisone;
Entacapone - COMT inhibitor
EPV - campylobacter - HSV

34. GBS
Tunnel vision - diaphoresis - nausea - pallor
IVIG and plasmapheresis
Despite the term neuroma they arise from schwann cells - schwanoma
Myasthenia; due to autoantibodies against acetylecholine receptor;

35. benign essential tremor
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
Acetylecholinersterase inhibitors
Obturator n lesion

36. What is can be used cluster headache prevention
Clonidine will take care both high bp and withdrawal
Verapamil
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
EPV - campylobacter - HSV

37. When to give aspirin when patient on tPA after stroke
Femoral n lesion
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
Not within 24 hours; give afte 24-48 hours if patient stable

38. medial thigh sensory loss and weakness in addcution
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
MS: CSF increased IgG -IgM and IgA also increased. not specific to 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
Obturator n lesion

39. How to differentiate traumatic LP and SAH
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Cerebral palsy; dx mri
Botulism has descending paralysis in contrast othere have ascending paralysis
Do CT scan at first to r/o SAH - if ct neg lumbar puncture

40. how donepezil - acetylecholinsterase inhibitor works in Alzheimers
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Nystagmus on far lateral gaze
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level

41. indication of plasmapheresis in GBS
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
90% of right handed and 60% of left handed persons; speech and language function
Verapamil
IVIG and plasmapheresis

42. How to confirm braindeath?
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
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.
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Difficulty in writing - calculating - distinguishing left and write

43. cortical lesion
Clonidine will take care both high bp and withdrawal
Botulism has descending paralysis in contrast othere have ascending paralysis
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Aphasia - neglect - agnosia - acalculia etc

44. When headache is presenting complaint of brain tumor
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
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
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID

45. hx of epilepsy - now unresponsive - slight twhiching of mouth and arms
Construction apraxia; lesion in non dominant parietal lobe (right)
Nystagmus on far lateral gaze
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
High dose IV methyleprednisone;

46. Blood transfusion in hypothermia
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
Difficulty in writing - calculating - distinguishing left and write
Aphasia - neglect - agnosia - acalculia etc

47. impaired vibration and increased DTR
Vitamin B12 deficiency
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Botulism has descending paralysis in contrast othere have ascending paralysis
Normal pressure hydrocephalus

48. How to tx acute exacerbation of MS
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
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
Taper gradually to prevent seizure relapse

49. How to perform apnea test
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
20%
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
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test

50. drags leg forward in every steps - no knee flexion; hip flexion and straight legs
Spastic paraparesis
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
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
Myasthenia; due to autoantibodies against acetylecholine receptor;