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. earliest sign of phenytoin toxicity
Nystagmus on far lateral gaze
MS
Taper gradually to prevent seizure relapse
Coronary artery disease

2. double vision at the end of day and ptosis
Myasthenia; due to autoantibodies against acetylecholine receptor;
Nystagmus on far lateral gaze
Cerebral palsy; dx mri
MS

3. headache - non reactive pupil - fall on both sides during walking - impaired upward gaze
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
90% of right handed and 60% of left handed persons; speech and language function
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
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;

4. prodrome of vasovagal syncope
EPV - campylobacter - HSV
Tunnel vision - diaphoresis - nausea - pallor
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Difficulty in writing - calculating - distinguishing left and write

5. When to use dopamine agonist pramipexol in parkinson
Obturator n lesion
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
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
Propranolol or primidone

6. labyrinthitis
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Difficulty in writing - calculating - distinguishing left and write
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure

7. MG
Clonidine will take care both high bp and withdrawal
Acetylecholinersterase inhibitors
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Construction apraxia; lesion in non dominant parietal lobe (right)

8. How to prevent prevent frequency of MS exacerbation
Vitamin B12 deficiency
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Clonidine will take care both high bp and withdrawal

9. What bp med to be given in a patient with high bp and signs of opioid withdrawal
Clonidine will take care both high bp and withdrawal
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Distal lower motor neuron disease

10. Acute onset of left arm weakness
Get up from chair walk a short distance turn around and sit; screening test for fall
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
It patient has electrolyte imbalance and hypothermia
Acetylecholinersterase inhibitors

11. excessive elevation of legs during walking (toe touch floor earlier than heels)
Aspirin - control HTN and swallow eval before giving any oral meds
Distal lower motor neuron disease
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Difficulty in writing - calculating - distinguishing left and write

12. How to manage stroke patient came within 4 hours
Corticosteroid and acyclovir
EPV - campylobacter - HSV
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
82% specific for dementia

13. 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

14. When to start fibrinolytic therapy in stroke patient?
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Difficulty in writing - calculating - distinguishing left and write
High dose IV methyleprednisone;
Gilberts disease

15. best diagnosis for parkinsonim
Botulism has descending paralysis in contrast othere have ascending paralysis
Clonidine will take care both high bp and withdrawal
Autospy gold standard
Distal lower motor neuron disease

16. GBS
IVIG and plasmapheresis
Cerebral palsy; dx mri
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure

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

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

18. phenytoin and OCP
Reduced efficacy of OCP
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge

19. How to confirm braindeath?
Diabetes insipidus
MS
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.
Entacapone - COMT inhibitor

20. severe headache and high BP
Obturator n lesion
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
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

21. Tx of GBS
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
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.
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
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

22. craniopharyngioma
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Botulism has descending paralysis in contrast othere have ascending paralysis
Diabetes insipidus
Aspirin - control HTN and swallow eval before giving any oral meds

23. cortical lesion
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Aphasia - neglect - agnosia - acalculia etc
90% of right handed and 60% of left handed persons; speech and language function
Corticosteroid and acyclovir

24. When headache is presenting complaint of brain tumor
Wernicke's encephalopathy; due to thiamine definition; medical emergency
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
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
RBC count >6000

25. botulism
Aphasia - neglect - agnosia - acalculia etc
MS
Antitoxin
Botulism has descending paralysis in contrast othere have ascending paralysis

26. infections in GBS
Lesion in nondominant temporal lobe
Coronary artery disease
EPV - campylobacter - HSV
It patient has electrolyte imbalance and hypothermia

27. Why V12 deficient develop hypokalemia after tx with b12
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Clonidine will take care both high bp and withdrawal
Aspirin - control HTN and swallow eval before giving any oral meds

28. What percent of dementia is reversible
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Wernicke's encephalopathy; due to thiamine definition; medical emergency
20%
Not within 24 hours; give afte 24-48 hours if patient stable

29. What mmse score suggest dementia
Aphasia - neglect - agnosia - acalculia etc
Nystagmus on far lateral gaze
<20; if patient scores >25 benign forgetfulness
MS

30. How to differentiate parkinson and benign essential tremor
Corticosteroid and acyclovir
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Spastic paraparesis
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

31. acoustic neuroma
Despite the term neuroma they arise from schwann cells - schwanoma
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;
Propranolol or primidone
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l

32. stroke with lower facial palsy - pronator drift despite on aspirin
Obturator n lesion
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
<20; if patient scores >25 benign forgetfulness
Vitamin B12 deficiency

33. 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
Lesion in nondominant temporal lobe
Cholinesterase inhibitor; and antiparkinsonism drugs
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening

34. korsafoff psychosis
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Reduced efficacy of OCP
Distal lower motor neuron disease
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty

35. dominant parietal lobe on the left side
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
90% of right handed and 60% of left handed persons; speech and language function
Deficit in cranial nerve function

36. contraindication of sumatripta
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
Botulism has descending paralysis in contrast othere have ascending paralysis
Coronary artery disease
Get up from chair walk a short distance turn around and sit; screening test for fall

37. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
Cerebral palsy; dx mri
Coronary artery disease
Reduced efficacy of OCP
Tunnel vision - diaphoresis - nausea - pallor

38. How to tx lewy body dementia
Femoral n lesion
Gilberts disease
Cholinesterase inhibitor; and antiparkinsonism drugs
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised

39. at first tingling in toes and feet then weakness in extremities
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening

40. MMSE score of less than 24
82% specific for dementia
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
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level

41. How to tx acute exacerbation of MS
Acetylecholinersterase inhibitors
EPV - campylobacter - HSV
Get up from chair walk a short distance turn around and sit; screening test for fall
High dose IV methyleprednisone;

42. walking like drunken sailor; jerky hesitant and walks in zigzag pattern
Construction apraxia; lesion in non dominant parietal lobe (right)
Cerebellar lesion
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
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement

43. What is pronator drift
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
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
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

44. Most effective to reduce aspiration in stroke or patient with swallowing dysfunction
Coronary artery disease
Upright supine position
Taper gradually to prevent seizure relapse
Obturator n lesion

45. how donepezil - acetylecholinsterase inhibitor works in Alzheimers
High dose IV methyleprednisone;
Cholinesterase inhibitor; and antiparkinsonism drugs
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
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. patient with hx of cluster headache p/w retroorbital pain lacrimation - vomiting suddenly
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID

47. 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
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
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;
Entacapone - COMT inhibitor

48. lesion in dominant parietal lobe
Femoral n lesion
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Difficulty in writing - calculating - distinguishing left and write
Acetylecholinersterase inhibitors

49. How to tx stroke patient came after 6h
Lesion in nondominant temporal lobe
Clonidine will take care both high bp and withdrawal
Aspirin - control HTN and swallow eval before giving any oral meds
Construction apraxia; lesion in non dominant parietal lobe (right)

50. What is can be used cluster headache prevention
Nystagmus on far lateral gaze
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Distal lower motor neuron disease
Verapamil