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. How to confirm braindeath?
20%
<20; if patient scores >25 benign forgetfulness
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.
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;

2. 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
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
<20; if patient scores >25 benign forgetfulness
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty

3. How to differentiate botulism from tick born paralysis - GBS and MG
Botulism has descending paralysis in contrast othere have ascending paralysis
Diabetes insipidus
EPV - campylobacter - HSV
RBC count >6000

4. Tx of GBS
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Clonidine will take care both high bp and withdrawal
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Despite the term neuroma they arise from schwann cells - schwanoma

5. When to give aspirin when patient on tPA after stroke
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
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
Not within 24 hours; give afte 24-48 hours if patient stable
Botulism has descending paralysis in contrast othere have ascending paralysis

6. How to stop antiepileptic drugs
Taper gradually to prevent seizure relapse
Vitamin B12 deficiency
IVIG and plasmapheresis
82% specific for dementia

7. craniopharyngioma
Propranolol or primidone
Diabetes insipidus
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
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica

8. at first tingling in toes and feet then weakness in extremities
Not within 24 hours; give afte 24-48 hours if patient stable
Aspirin - control HTN and swallow eval before giving any oral meds
Coronary artery disease
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure

9. How to perform apnea test
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
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
Autospy gold standard

10. dominant parietal lobe on the left side
90% of right handed and 60% of left handed persons; speech and language function
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Aphasia - neglect - agnosia - acalculia etc

11. What bp med to be given in a patient with high bp and signs of opioid withdrawal
Lesion in nondominant temporal lobe
Cerebellar lesion
Vitamin B12 deficiency
Clonidine will take care both high bp and withdrawal

12. 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.
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
EPV - campylobacter - HSV
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica

13. How to tx stroke patient came after 6h
Aspirin - control HTN and swallow eval before giving any oral meds
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Aphasia - neglect - agnosia - acalculia etc

14. Acute onset of left arm weakness
Get up from chair walk a short distance turn around and sit; screening test for fall
Coronary artery disease
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Gilberts disease

15. When to start fibrinolytic therapy in stroke patient?
Acetylecholinersterase inhibitors
Not within 24 hours; give afte 24-48 hours if patient stable
Cerebellar lesion
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge

16. headache - non reactive pupil - fall on both sides during walking - impaired upward gaze
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Diabetes insipidus
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
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 suspect traumatic LP
Botulism has descending paralysis in contrast othere have ascending paralysis
Propranolol or primidone
RBC count >6000
Vitamin B12 deficiency

18. dementia plus urinary incontinence
Distal lower motor neuron disease
20%
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
Normal pressure hydrocephalus

19. How to differentiate parkinson and benign essential tremor
Cholinesterase inhibitor; and antiparkinsonism drugs
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
Vitamin B12 deficiency
Aspirin - control HTN and swallow eval before giving any oral meds

20. 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
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Reduced efficacy of OCP
Entacapone - COMT inhibitor

21. How to differentiate medial and lateral pontine syndrome
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
Construction apraxia; lesion in non dominant parietal lobe (right)
Aspirin - control HTN and swallow eval before giving any oral meds
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. oligoclonal band in CSF
MS
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
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Obturator n lesion

23. Most effective to reduce aspiration in stroke or patient with swallowing dysfunction
Upright supine position
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
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

24. Blood transfusion in hypothermia
Antitoxin
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Entacapone - COMT inhibitor
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA

25. Patient with carbamazepine; What should be advice?
Reduced efficacy of OCP
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Wernicke's encephalopathy; due to thiamine definition; medical emergency
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

26. GBS
IVIG and plasmapheresis
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Myasthenia; due to autoantibodies against acetylecholine receptor;
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.

27. prodrome of vasovagal syncope
Not within 24 hours; give afte 24-48 hours if patient stable
Tunnel vision - diaphoresis - nausea - pallor
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
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

28. brain stem lesion
Deficit in cranial nerve function
Antitoxin
Despite the term neuroma they arise from schwann cells - schwanoma
Normal pressure hydrocephalus

29. Should we tx htn in acute ischemic stroke

30. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
Normal pressure hydrocephalus
Spastic paraparesis
Antitoxin
Cerebral palsy; dx mri

31. what drug is used to extend effects of levodopa
Propranolol or primidone
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
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
Entacapone - COMT inhibitor

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

33. How to tx acute exacerbation of MS
High dose IV methyleprednisone;
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Spastic paraparesis

34. differentiate picks and huntington
Diabetes insipidus
Nystagmus on far lateral gaze
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
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure

35. hx of epilepsy - now unresponsive - slight twhiching of mouth and arms
It patient has electrolyte imbalance and hypothermia
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
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

36. contraindication of sumatripta
Coronary artery disease
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
RBC count >6000
High dose IV methyleprednisone;

37. drags leg forward in every steps - no knee flexion; hip flexion and straight legs
Spastic paraparesis
RBC count >6000
Normal pressure hydrocephalus
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa

38. walking like drunken sailor; jerky hesitant and walks in zigzag pattern
Nystagmus on far lateral gaze
Cerebellar lesion
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then 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

39. women with unilateral eye pain; neurlogic symptoms here there at different times
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Diabetes insipidus
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test

40. lesion in dominant tempora lobe
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Get up from chair walk a short distance turn around and sit; screening test for fall
Difficulty in writing - calculating - distinguishing left and write
Vitamin B12 deficiency

41. acoustic neuroma
Entacapone - COMT inhibitor
Distal lower motor neuron disease
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Despite the term neuroma they arise from schwann cells - schwanoma

42. stroke with lower facial palsy - pronator drift despite on aspirin
Lesion in nondominant temporal lobe
Get up from chair walk a short distance turn around and sit; screening test for fall
90% of right handed and 60% of left handed persons; speech and language function
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel

43. When to use brain spect scintigraphy to confirm brain death
It patient has electrolyte imbalance and hypothermia
Aspirin - control HTN and swallow eval before giving any oral meds
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure

44. patient with hx of cluster headache p/w retroorbital pain lacrimation - vomiting suddenly
Spastic paraparesis
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Autospy gold standard

45. earliest sign of phenytoin toxicity
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Nystagmus on far lateral gaze
Distal lower motor neuron disease
Coronary artery disease

46. lesion in dominant parietal lobe
Coronary artery disease
Difficulty in writing - calculating - distinguishing left and write
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Autospy gold standard

47. How to tx lewy body dementia
Cholinesterase inhibitor; and antiparkinsonism drugs
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin

48. severe headache and high BP
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Verapamil
High dose IV methyleprednisone;
Do CT scan at first to r/o SAH - if ct neg lumbar puncture

49. benign essential tremor
EPV - campylobacter - HSV
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Lesion in nondominant temporal lobe
Propranolol or primidone

50. When headache is presenting complaint of brain tumor
IVIG and plasmapheresis
82% specific for dementia
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Deficit in cranial nerve function