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. phenytoin and OCP
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Reduced efficacy of OCP
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure

2. what drug is used to extend effects of levodopa
Not within 24 hours; give afte 24-48 hours if patient stable
Entacapone - COMT inhibitor
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;
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID

3. stroke with lower facial palsy - pronator drift despite on aspirin
Taper gradually to prevent seizure relapse
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
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

4. How to differentiate parkinson and benign essential tremor
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
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
Femoral n lesion
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.

5. Patient with carbamazepine; What should be advice?
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Deficit in cranial nerve function
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

6. 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
Acetylecholinersterase inhibitors
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Obturator n lesion

7. Why V12 deficient develop hypokalemia after tx with b12
Vitamin B12 deficiency
Femoral n lesion
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48

8. What mmse score suggest dementia
Cerebral palsy; dx mri
Construction apraxia; lesion in non dominant parietal lobe (right)
EPV - campylobacter - HSV
<20; if patient scores >25 benign forgetfulness

9. How to differentiate medial and lateral pontine syndrome
Difficulty in writing - calculating - distinguishing left and write
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
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

10. dominant parietal lobe on the left side
90% of right handed and 60% of left handed persons; speech and language function
Cerebral palsy; dx mri
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

11. korsafoff psychosis
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
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;
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
High dose IV methyleprednisone;

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

13. How to tx lewy body dementia
Cholinesterase inhibitor; and antiparkinsonism drugs
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
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

14. impaired vibration and increased DTR
RBC count >6000
<20; if patient scores >25 benign forgetfulness
Vitamin B12 deficiency
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

15. dementia plus urinary incontinence
Acetylecholinersterase inhibitors
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
RBC count >6000
Normal pressure hydrocephalus

16. get up and go test
Get up from chair walk a short distance turn around and sit; screening test for fall
Construction apraxia; lesion in non dominant parietal lobe (right)
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure

17. labyrinthitis
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Despite the term neuroma they arise from schwann cells - schwanoma
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel

18. infections in GBS
EPV - campylobacter - HSV
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Botulism has descending paralysis in contrast othere have ascending paralysis
Spastic paraparesis

19. walking like drunken sailor; jerky hesitant and walks in zigzag pattern
Cerebellar lesion
IVIG and plasmapheresis
Normal pressure hydrocephalus
RBC count >6000

20. drags leg forward in every steps - no knee flexion; hip flexion and straight legs
Obturator n lesion
Verapamil
Spastic paraparesis
Get up from chair walk a short distance turn around and sit; screening test for fall

21. How to tx acute exacerbation of MS
High dose IV methyleprednisone;
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Cerebral palsy; dx mri
Coronary artery disease

22. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
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
Femoral n lesion
Cerebral palsy; dx mri

23. oligoclonal band in CSF
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
IVIG and plasmapheresis
MS
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel

24. differentiate wenicke and korsakoff
Botulism has descending paralysis in contrast othere have ascending paralysis
High dose IV methyleprednisone;
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
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge

25. contraindication of sumatripta
Entacapone - COMT inhibitor
Coronary artery disease
Botulism has descending paralysis in contrast othere have ascending paralysis
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement

26. Most effective to reduce aspiration in stroke or patient with swallowing dysfunction
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Taper gradually to prevent seizure relapse
Upright supine position
<20; if patient scores >25 benign forgetfulness

27. What is pronator drift
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
Aphasia - neglect - agnosia - acalculia etc
Vitamin B12 deficiency
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

28. earliest sign of phenytoin toxicity
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
Nystagmus on far lateral gaze
Difficulty in writing - calculating - distinguishing left and write
Botulism has descending paralysis in contrast othere have ascending paralysis

29. benign essential tremor
82% specific for dementia
Propranolol or primidone
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
RBC count >6000

30. Tx of bells palsy
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
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
Corticosteroid and acyclovir

31. impaired hepatic conjugation of billirubin
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
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Gilberts disease

32. craniopharyngioma
Construction apraxia; lesion in non dominant parietal lobe (right)
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
IVIG and plasmapheresis
Diabetes insipidus

33. Should we tx htn in acute ischemic stroke

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

34. When to suspect traumatic LP
Lesion in nondominant temporal lobe
RBC count >6000
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner

35. How to stop antiepileptic drugs
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
It patient has electrolyte imbalance and hypothermia
Gilberts disease
Taper gradually to prevent seizure relapse

36. How to diffrentiate tick borne paralysis from GBS and spinal cord tumor
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Obturator n lesion
Tunnel vision - diaphoresis - nausea - pallor
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal

37. cortical lesion
Aphasia - neglect - agnosia - acalculia etc
High dose IV methyleprednisone;
Difficulty in writing - calculating - distinguishing left and write
Despite the term neuroma they arise from schwann cells - schwanoma

38. construction worker works in squatting position; now develop decreased sensation over anterolateral thigh
Deficit in cranial nerve function
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;
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica

39. MG
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Acetylecholinersterase inhibitors
RBC count >6000

40. botulism
IVIG and plasmapheresis
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;
Deficit in cranial nerve function
Antitoxin

41. When to give aspirin when patient on tPA after stroke
Verapamil
Not within 24 hours; give afte 24-48 hours if patient stable
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
20%

42. When headache is presenting complaint of brain tumor
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
90% of right handed and 60% of left handed persons; speech and language function
Aspirin - control HTN and swallow eval before giving any oral meds
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening

43. What bp med to be given in a patient with high bp and signs of opioid withdrawal
Difficulty in writing - calculating - distinguishing left and write
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Lesion in nondominant temporal lobe
Clonidine will take care both high bp and withdrawal

44. best diagnosis for parkinsonim
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
Corticosteroid and acyclovir
Despite the term neuroma they arise from schwann cells - schwanoma
Autospy gold standard

45. Blood transfusion in hypothermia
It patient has electrolyte imbalance and hypothermia
Normal pressure hydrocephalus
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement

46. differentiate lewy body dementia and vascular dementia
MS
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
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48

47. MMSE score of less than 24
Reduced efficacy of OCP
EPV - campylobacter - HSV
82% specific for dementia
Cholinesterase inhibitor; and antiparkinsonism drugs

48. What percent of dementia is reversible
20%
Vitamin B12 deficiency
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Reduced efficacy of OCP

49. How to differentiate botulism from tick born paralysis - GBS and MG
Upright supine position
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Botulism has descending paralysis in contrast othere have ascending paralysis
Cerebellar lesion

50. How to manage stroke patient came within 4 hours
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
Distal lower motor neuron disease
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;