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Test your basic knowledge |
USMLE Step3 Neurology
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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. hx of epilepsy - now unresponsive - slight twhiching of mouth and arms
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;
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Cerebellar lesion
It patient has electrolyte imbalance and hypothermia
2. MG
Clonidine will take care both high bp and withdrawal
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Acetylecholinersterase inhibitors
Cholinesterase inhibitor; and antiparkinsonism drugs
3. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
82% specific for dementia
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
Cerebral palsy; dx mri
4. How to differentiate traumatic LP and SAH
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
5. When to suspect traumatic LP
RBC count >6000
Nystagmus on far lateral gaze
Cerebral palsy; dx mri
Autospy gold standard
6. dominant parietal lobe on the left side
90% of right handed and 60% of left handed persons; speech and language function
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
7. cluster headache
Nystagmus on far lateral gaze
Autospy gold standard
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
<20; if patient scores >25 benign forgetfulness
8. Blood transfusion in hypothermia
Antitoxin
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
9. 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
Diabetes insipidus
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
10. GBS
90% of right handed and 60% of left handed persons; speech and language function
IVIG and plasmapheresis
<20; if patient scores >25 benign forgetfulness
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;
11. Should we tx htn in acute ischemic stroke
12. patient with hx of cluster headache p/w retroorbital pain lacrimation - vomiting suddenly
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
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
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
13. When to give aspirin when patient on tPA after stroke
Not within 24 hours; give afte 24-48 hours if patient stable
Gilberts disease
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
14. What bp med to be given in a patient with high bp and signs of opioid withdrawal
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Propranolol or primidone
Cholinesterase inhibitor; and antiparkinsonism drugs
Clonidine will take care both high bp and withdrawal
15. construction worker works in squatting position; now develop decreased sensation over anterolateral thigh
Taper gradually to prevent seizure relapse
Diabetes insipidus
EPV - campylobacter - HSV
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
16. How to differentiate dementias
High dose IV methyleprednisone;
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Taper gradually to prevent seizure relapse
Follows viral illness; vertigo - tinnitus - nausea. self limiting
17. impaired perception of complex sounds
Lesion in nondominant temporal lobe
Reduced efficacy of OCP
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Vitamin B12 deficiency
18. How to confirm braindeath?
Difficulty in writing - calculating - distinguishing left and write
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.
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
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
19. prodrome of vasovagal syncope
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Tunnel vision - diaphoresis - nausea - pallor
Botulism has descending paralysis in contrast othere have ascending paralysis
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
20. differentiate wenicke and korsakoff
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
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
90% of right handed and 60% of left handed persons; speech and language function
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
21. What percent of dementia is reversible
20%
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Cerebellar lesion
Verapamil
22. dementia plus urinary incontinence
Construction apraxia; lesion in non dominant parietal lobe (right)
Normal pressure hydrocephalus
Verapamil
Botulism has descending paralysis in contrast othere have ascending paralysis
23. medial thigh sensory loss and weakness in addcution
EPV - campylobacter - HSV
Get up from chair walk a short distance turn around and sit; screening test for fall
82% specific for dementia
Obturator n lesion
24. impaired hepatic conjugation of billirubin
Gilberts disease
It patient has electrolyte imbalance and hypothermia
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
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
25. walking like drunken sailor; jerky hesitant and walks in zigzag pattern
Cerebellar lesion
Construction apraxia; lesion in non dominant parietal lobe (right)
Follows viral illness; vertigo - tinnitus - nausea. self limiting
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
26. alcoholic p/w confusion - ataxia - tremor - nystamgus
27. indication of plasmapheresis in GBS
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; 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
28. How to differentiate parkinson and benign essential tremor
Normal pressure hydrocephalus
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
Diabetes insipidus
Obturator n lesion
29. phenytoin and OCP
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
Upright supine position
RBC count >6000
Reduced efficacy of OCP
30. contraindication of sumatripta
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Coronary artery disease
<20; if patient scores >25 benign forgetfulness
Verapamil
31. craniopharyngioma
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
Diabetes insipidus
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Corticosteroid and acyclovir
32. What mmse score suggest dementia
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
<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
33. best diagnosis for parkinsonim
Nystagmus on far lateral gaze
Propranolol or primidone
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
34. drags leg forward in every steps - no knee flexion; hip flexion and straight legs
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Spastic paraparesis
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Cholinesterase inhibitor; and antiparkinsonism drugs
35. lesion in dominant tempora lobe
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Upright supine position
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Spastic paraparesis
36. When to start fibrinolytic therapy in stroke patient?
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
37. How to differentiate medial and lateral medullary syndrome
Vitamin B12 deficiency
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
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;
Taper gradually to prevent seizure relapse
38. Unable to copy of matchstick - unable to dress up
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
Clonidine will take care both high bp and withdrawal
Construction apraxia; lesion in non dominant parietal lobe (right)
EPV - campylobacter - HSV
39. cortical lesion
<20; if patient scores >25 benign forgetfulness
Aphasia - neglect - agnosia - acalculia etc
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
EPV - campylobacter - HSV
40. What is pronator drift
Distal lower motor neuron disease
Myasthenia; due to autoantibodies against acetylecholine receptor;
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
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
41. headache - non reactive pupil - fall on both sides during walking - impaired upward gaze
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Lesion in nondominant temporal lobe
Despite the term neuroma they arise from schwann cells - schwanoma
42. How to tx stroke patient came after 6h
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
Aspirin - control HTN and swallow eval before giving any oral meds
Cerebellar lesion
Botulism has descending paralysis in contrast othere have ascending paralysis
43. How to tx lewy body dementia
Vitamin B12 deficiency
Cholinesterase inhibitor; and antiparkinsonism drugs
Taper gradually to prevent seizure relapse
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
44. MMSE score of less than 24
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
82% specific for dementia
EPV - campylobacter - HSV
45. How to stop antiepileptic drugs
Taper gradually to prevent seizure relapse
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Cerebellar lesion
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
46. double vision at the end of day and ptosis
Botulism has descending paralysis in contrast othere have ascending paralysis
Follows viral illness; vertigo - tinnitus - nausea. self limiting
IVIG and plasmapheresis
Myasthenia; due to autoantibodies against acetylecholine receptor;
47. When headache is presenting complaint of brain tumor
Spastic paraparesis
RBC count >6000
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
High dose IV methyleprednisone;
48. differentiate lewy body dementia and vascular dementia
Spastic paraparesis
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
Clonidine will take care both high bp and withdrawal
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
49. korsafoff psychosis
Upright supine position
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
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.
50. acoustic neuroma
20%
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Despite the term neuroma they arise from schwann cells - schwanoma
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH