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USMLE Step3 Neurology

Subjects : health-sciences, usmle-step-3

Instructions:

Answer 50 questions in 30 minutes.
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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 perform apnea test
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
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
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test

2. What is can be used cluster headache prevention
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
Verapamil
Deficit in cranial nerve function

3. oligoclonal band in CSF
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Construction apraxia; lesion in non dominant parietal lobe (right)
MS

4. lesion in dominant parietal lobe
Obturator n lesion
Difficulty in writing - calculating - distinguishing left and write
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Despite the term neuroma they arise from schwann cells - schwanoma

5. How to diffrentiate tick borne paralysis from GBS and spinal cord tumor
20%
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Normal pressure hydrocephalus
Aphasia - neglect - agnosia - acalculia etc

6. earliest sign of phenytoin toxicity
Gilberts disease
Nystagmus on far lateral gaze
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement

7. women with unilateral eye pain; neurlogic symptoms here there at different times
Reduced efficacy of OCP
Despite the term neuroma they arise from schwann cells - schwanoma
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty

8. contraindication of sumatripta
Propranolol or primidone
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Coronary artery disease

9. at first tingling in toes and feet then weakness in extremities
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Verapamil
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level

10. lesion in dominant tempora lobe
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Upright supine position
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Do CT scan at first to r/o SAH - if ct neg lumbar puncture

11. When to suspect traumatic LP
Normal pressure hydrocephalus
Construction apraxia; lesion in non dominant parietal lobe (right)
RBC count >6000
Reduced efficacy of OCP

12. brain stem lesion
Clonidine will take care both high bp and withdrawal
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
Deficit in cranial nerve function
Get up from chair walk a short distance turn around and sit; screening test for fall

13. Tx of GBS
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
Botulism has descending paralysis in contrast othere have ascending paralysis
Spastic paraparesis

14. How to prevent prevent frequency of MS exacerbation
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
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
Tunnel vision - diaphoresis - nausea - pallor

15. cluster headache
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
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
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

16. How to manage stroke patient came within 4 hours
Gilberts disease
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;

17. drags leg forward in every steps - no knee flexion; hip flexion and straight legs
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Spastic paraparesis
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
High dose IV methyleprednisone;

18. MMSE score of less than 24
Difficulty in writing - calculating - distinguishing left and write
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
82% specific for dementia

19. How to tx lewy body dementia
Cholinesterase inhibitor; and antiparkinsonism drugs
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
Femoral n lesion
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement

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
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
90% of right handed and 60% of left handed persons; speech and language function
EPV - campylobacter - HSV

21. hx of epilepsy - now unresponsive - slight twhiching of mouth and arms
Get up from chair walk a short distance turn around and sit; screening test for fall
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;
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

22. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
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.
Cerebral palsy; dx mri
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Coronary artery disease

23. How to differentiate medial and lateral medullary 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
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
90% of right handed and 60% of left handed persons; speech and language function

24. How to differentiate dementias
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Antitoxin
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l

25. When to use brain spect scintigraphy to confirm brain death
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Nystagmus on far lateral gaze
Cholinesterase inhibitor; and antiparkinsonism drugs
It patient has electrolyte imbalance and hypothermia

26. How to stop antiepileptic drugs
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Taper gradually to prevent seizure relapse
Deficit in cranial nerve function

27. impaired perception of complex sounds
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Lesion in nondominant temporal lobe

28. what drug is used to extend effects of levodopa
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
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
Clonidine will take care both high bp and withdrawal
Entacapone - COMT inhibitor

29. How to differentiate traumatic LP and SAH
Botulism has descending paralysis in contrast othere have ascending paralysis
Taper gradually to prevent seizure relapse
Clonidine will take care both high bp and withdrawal
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH

30. labyrinthitis
IVIG and plasmapheresis
Taper gradually to prevent seizure relapse
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Follows viral illness; vertigo - tinnitus - nausea. self limiting

31. indication of plasmapheresis in GBS
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Difficulty in writing - calculating - distinguishing left and write
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Deficit in cranial nerve function

32. How to differentiate medial and lateral pontine syndrome
Verapamil
Tunnel vision - diaphoresis - nausea - pallor
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
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

33. severe headache and high BP
Aphasia - neglect - agnosia - acalculia etc
Vitamin B12 deficiency
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
90% of right handed and 60% of left handed persons; speech and language function

34. korsafoff psychosis
82% specific for dementia
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Myasthenia; due to autoantibodies against acetylecholine receptor;
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. double vision at the end of day and ptosis
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Myasthenia; due to autoantibodies against acetylecholine receptor;
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
Difficulty in writing - calculating - distinguishing left and write

36. Unable to copy of matchstick - unable to dress up
Coronary artery 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
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Construction apraxia; lesion in non dominant parietal lobe (right)

37. dementia plus urinary incontinence
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Cholinesterase inhibitor; and antiparkinsonism drugs
Normal pressure hydrocephalus
Verapamil

38. When headache is presenting complaint of brain tumor
Tunnel vision - diaphoresis - nausea - pallor
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Follows viral illness; vertigo - tinnitus - nausea. self limiting
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

39. anerior and anteriomedial thigh paresthesia - decreased DTR
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
It patient has electrolyte imbalance and hypothermia
Femoral n lesion
Diabetes insipidus

40. excessive elevation of legs during walking (toe touch floor earlier than heels)
Distal lower motor neuron disease
Nystagmus on far lateral gaze
Propranolol or primidone
Coronary artery disease

41. infections in GBS
EPV - campylobacter - HSV
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
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

42. Blood transfusion in hypothermia
Coronary artery disease
RBC count >6000
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS

43. Most effective to reduce aspiration in stroke or patient with swallowing dysfunction
Get up from chair walk a short distance turn around and sit; screening test for fall
Upright supine position
Gilberts disease
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty

44. walking like drunken sailor; jerky hesitant and walks in zigzag pattern
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Cerebellar lesion
Lesion in nondominant temporal lobe
Entacapone - COMT inhibitor

45. differentiate lewy body dementia and vascular dementia
Propranolol or primidone
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;
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
High dose IV methyleprednisone;

46. GBS
Vitamin B12 deficiency
IVIG and plasmapheresis
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Upright supine position

47. best diagnosis for parkinsonim
Myasthenia; due to autoantibodies against acetylecholine receptor;
Deficit in cranial nerve function
Autospy gold standard
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.

48. How to differentiate parkinson and benign essential tremor
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
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal

49. How to confirm braindeath?
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.
Diabetes insipidus
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
Spastic paraparesis

50. Acute onset of left arm weakness
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Antitoxin
EPV - campylobacter - HSV
Despite the term neuroma they arise from schwann cells - schwanoma

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Test your basic knowledge |

USMLE Step3 Neurology

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3d Computer Modeling

Actionscript

Adobe Flash

Adobe Illustrator

Adobe Illustrator Shortcuts

Adobe Indesign Publishing

Adobe Photoshop CS 2 - CS 3

Adobe Photoshop CS 5

Adobe Photoshop CS 5 Keyboard Shortcuts

Adobe Photoshop Graphic Design

Adobe Photoshop Tools And Commands

Adobe Premiere Keyboard Shortcuts

Adobe Premiere Pro

After Effects Keyboard Shortcuts

Agile Development

Agile Scrum Methodology

Ajax

Android Programming

Animation

Asp.net Programming