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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. anerior and anteriomedial thigh paresthesia - decreased DTR
Femoral n lesion
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Diabetes insipidus
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level

2. contraindication of sumatripta
Reduced efficacy of OCP
Coronary artery disease
<20; if patient scores >25 benign forgetfulness
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

3. excessive elevation of legs during walking (toe touch floor earlier than heels)
Cerebral palsy; dx mri
EPV - campylobacter - HSV
Distal lower motor neuron disease
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement

4. lesion in dominant parietal lobe
Difficulty in writing - calculating - distinguishing left and write
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
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
It patient has electrolyte imbalance and hypothermia

5. acoustic neuroma
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
Despite the term neuroma they arise from schwann cells - schwanoma
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
20%

6. indication of plasmapheresis in GBS
IVIG and plasmapheresis
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Not within 24 hours; give afte 24-48 hours if patient stable
Lesion in nondominant temporal lobe

7. brain stem lesion
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
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Verapamil
Deficit in cranial nerve function

8. How to perform apnea test
Not within 24 hours; give afte 24-48 hours if patient stable
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
EPV - campylobacter - HSV
Corticosteroid and acyclovir

9. When to use dopamine agonist pramipexol in parkinson
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Verapamil
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa

10. what drug is used to extend effects of levodopa
Femoral n lesion
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Entacapone - COMT inhibitor
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

11. Why V12 deficient develop hypokalemia after tx with b12
Acetylecholinersterase inhibitors
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised

12. How to differentiate traumatic LP and SAH
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Vitamin B12 deficiency
Acetylecholinersterase inhibitors
Not within 24 hours; give afte 24-48 hours if patient stable

13. differentiate wenicke and korsakoff
Clonidine will take care both high bp and withdrawal
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
Normal pressure hydrocephalus

14. MG
90% of right handed and 60% of left handed persons; speech and language function
Acetylecholinersterase inhibitors
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement

15. prodrome of vasovagal syncope
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
Tunnel vision - diaphoresis - nausea - pallor
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
Not within 24 hours; give afte 24-48 hours if patient stable

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
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
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
Despite the term neuroma they arise from schwann cells - schwanoma

17. How to tx lewy body dementia
Coronary artery disease
Verapamil
Cholinesterase inhibitor; and antiparkinsonism drugs
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID

18. When to start fibrinolytic therapy in stroke patient?
<20; if patient scores >25 benign forgetfulness
Normal pressure hydrocephalus
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge

19. What is can be used cluster headache prevention
Myasthenia; due to autoantibodies against acetylecholine receptor;
Reduced efficacy of OCP
Verapamil
Lesion in nondominant temporal lobe

20. phenytoin and OCP
Vitamin B12 deficiency
Reduced efficacy of OCP
Taper gradually to prevent seizure relapse
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel

21. best diagnosis for parkinsonim
20%
Autospy gold standard
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
90% of right handed and 60% of left handed persons; speech and language function

22. impaired hepatic conjugation of billirubin
Gilberts disease
Deficit in cranial nerve function
Despite the term neuroma they arise from schwann cells - schwanoma
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement

23. GBS
EPV - campylobacter - HSV
IVIG and plasmapheresis
Gilberts disease
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy

24. Tx of bells palsy
Cerebral palsy; dx mri
Corticosteroid and acyclovir
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.
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica

25. severe headache and high BP
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure

26. MMSE score of less than 24
Not within 24 hours; give afte 24-48 hours if patient stable
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
82% specific for dementia
Distal lower motor neuron disease

27. When to suspect traumatic LP
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
RBC count >6000
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

28. craniopharyngioma
Diabetes insipidus
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH

29. walking like drunken sailor; jerky hesitant and walks in zigzag pattern
Cerebellar lesion
Corticosteroid and acyclovir
82% specific for dementia
Vitamin B12 deficiency

30. What is pronator drift
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
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
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure

31. cluster headache
Clonidine will take care both high bp and withdrawal
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
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty

32. When to give aspirin when patient on tPA after stroke
Lesion in nondominant temporal lobe
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Not within 24 hours; give afte 24-48 hours if patient stable
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l

33. botulism
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
Autospy gold standard
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
Antitoxin

34. women with unilateral eye pain; neurlogic symptoms here there at different times
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
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.
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

35. at first tingling in toes and feet then weakness in extremities
Autospy gold standard
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
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
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure

36. How to prevent prevent frequency of MS exacerbation
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Aphasia - neglect - agnosia - acalculia etc
Acetylecholinersterase inhibitors
Gilberts disease

37. drags leg forward in every steps - no knee flexion; hip flexion and straight legs
Spastic paraparesis
Acetylecholinersterase inhibitors
Aspirin - control HTN and swallow eval before giving any oral meds
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;

38. headache - non reactive pupil - fall on both sides during walking - impaired upward gaze
20%
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Deficit in cranial nerve function

39. infections in GBS
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.
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
EPV - campylobacter - HSV
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

40. impaired vibration and increased DTR
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
Vitamin B12 deficiency
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
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel

41. Acute onset of left arm weakness
Acetylecholinersterase inhibitors
It patient has electrolyte imbalance and hypothermia
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA

42. How to stop antiepileptic drugs
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
Not within 24 hours; give afte 24-48 hours if patient stable
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Taper gradually to prevent seizure relapse

43. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
It patient has electrolyte imbalance and hypothermia
Cerebral palsy; dx mri
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;
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge

44. how donepezil - acetylecholinsterase inhibitor works in Alzheimers
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
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
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Not within 24 hours; give afte 24-48 hours if patient stable

45. labyrinthitis
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Tunnel vision - diaphoresis - nausea - pallor
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
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised

46. Blood transfusion in hypothermia
Diabetes insipidus
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Cerebellar lesion

47. When to use brain spect scintigraphy to confirm brain death
It patient has electrolyte imbalance and hypothermia
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
Not within 24 hours; give afte 24-48 hours if patient stable
Corticosteroid and acyclovir

48. How to tx acute exacerbation of MS
Coronary artery disease
High dose IV methyleprednisone;
Spastic paraparesis
Cholinesterase inhibitor; and antiparkinsonism drugs

49. What percent of dementia is reversible
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
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
Antitoxin
20%

50. 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
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
Femoral n lesion