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. Most effective to reduce aspiration in stroke or patient with swallowing dysfunction
IVIG and plasmapheresis
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Upright supine position
Entacapone - COMT inhibitor

2. When headache is presenting complaint of brain tumor
Propranolol or primidone
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
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

3. How to tx stroke patient came after 6h
Cholinesterase inhibitor; and antiparkinsonism drugs
Aspirin - control HTN and swallow eval before giving any oral meds
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.
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH

4. MG
Aphasia - neglect - agnosia - acalculia etc
Acetylecholinersterase inhibitors
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised

5. phenytoin and OCP
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
Reduced efficacy of OCP
Distal lower motor neuron disease
Botulism has descending paralysis in contrast othere have ascending paralysis

6. differentiate wenicke and korsakoff
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Myasthenia; due to autoantibodies against acetylecholine receptor;
Corticosteroid and acyclovir
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

7. Tx of bells palsy
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
82% specific for dementia
Corticosteroid and acyclovir
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID

8. 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
EPV - campylobacter - HSV
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
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

9. get up and go test
82% specific for dementia
Get up from chair walk a short distance turn around and sit; screening test for fall
Entacapone - COMT inhibitor
Aspirin - control HTN and swallow eval before giving any oral meds

10. headache - non reactive pupil - fall on both sides during walking - impaired upward gaze
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Aspirin - control HTN and swallow eval before giving any oral meds
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Get up from chair walk a short distance turn around and sit; screening test for fall

11. When to start fibrinolytic therapy in stroke patient?
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
RBC count >6000
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Femoral n lesion

12. How to perform apnea test
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
Reduced efficacy of OCP
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test

13. cortical lesion
Aphasia - neglect - agnosia - acalculia etc
EPV - campylobacter - HSV
Femoral n lesion
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure

14. double vision at the end of day and ptosis
Nystagmus on far lateral gaze
82% specific for dementia
Myasthenia; due to autoantibodies against acetylecholine receptor;
Coronary artery disease

15. How to confirm braindeath?
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
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.
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised

16. impaired hepatic conjugation of billirubin
Gilberts disease
<20; if patient scores >25 benign forgetfulness
Difficulty in writing - calculating - distinguishing left and write
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

17. infections in GBS
Despite the term neuroma they arise from schwann cells - schwanoma
Upright supine position
EPV - campylobacter - HSV
MS

18. acoustic neuroma
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Despite the term neuroma they arise from schwann cells - schwanoma
High dose IV methyleprednisone;
It patient has electrolyte imbalance and hypothermia

19. drags leg forward in every steps - no knee flexion; hip flexion and straight legs
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Diabetes insipidus
Spastic paraparesis
Not within 24 hours; give afte 24-48 hours if patient stable

20. oligoclonal band in CSF
MS
Autospy gold standard
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.

21. How to differentiate dementias
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
82% specific for dementia
Distal lower motor neuron disease
It patient has electrolyte imbalance and hypothermia

22. How to diffrentiate tick borne paralysis from GBS and spinal cord tumor
Cerebellar lesion
Verapamil
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
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal

23. anerior and anteriomedial thigh paresthesia - decreased DTR
20%
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Femoral n lesion
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

24. 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
Botulism has descending paralysis in contrast othere have ascending paralysis
RBC count >6000
Obturator n lesion

25. What is pronator drift
Tunnel vision - diaphoresis - nausea - pallor
Distal lower motor neuron disease
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
Construction apraxia; lesion in non dominant parietal lobe (right)

26. prodrome of vasovagal syncope
Not within 24 hours; give afte 24-48 hours if patient stable
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Tunnel vision - diaphoresis - nausea - pallor

27. Tx of GBS
Botulism has descending paralysis in contrast othere have ascending paralysis
Spastic paraparesis
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS

28. indication of plasmapheresis in GBS
Autospy gold standard
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Obturator n lesion
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure

29. earliest sign of phenytoin toxicity
Diabetes insipidus
Botulism has descending paralysis in contrast othere have ascending paralysis
Nystagmus on far lateral gaze
Obturator n lesion

30. women with unilateral eye pain; neurlogic symptoms here there at different times
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
RBC count >6000
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS

31. lesion in dominant parietal lobe
Normal pressure hydrocephalus
Difficulty in writing - calculating - distinguishing left and write
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Myasthenia; due to autoantibodies against acetylecholine receptor;

32. When to use brain spect scintigraphy to confirm brain death
Upright supine position
Distal lower motor neuron disease
It patient has electrolyte imbalance and hypothermia
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;

33. craniopharyngioma
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
82% specific for dementia
Not within 24 hours; give afte 24-48 hours if patient stable

34. Unable to copy of matchstick - unable to dress up
Construction apraxia; lesion in non dominant parietal lobe (right)
Acetylecholinersterase inhibitors
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
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

35. When to give aspirin when patient on tPA after stroke
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Not within 24 hours; give afte 24-48 hours if patient stable
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Reduced efficacy of OCP

36. brain stem lesion
Deficit in cranial nerve function
IVIG and plasmapheresis
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica

37. How to manage stroke patient came within 4 hours
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
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
Vitamin B12 deficiency

38. How to prevent prevent frequency of MS exacerbation
Gilberts disease
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening

39. benign essential tremor
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Propranolol or primidone
Aspirin - control HTN and swallow eval before giving any oral meds
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin

40. How to tx acute exacerbation of MS
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
High dose IV methyleprednisone;
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy

41. medial thigh sensory loss and weakness in addcution
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.
Difficulty in writing - calculating - distinguishing left and write
Deficit in cranial nerve function
Obturator n lesion

42. How to tx lewy body dementia
Difficulty in writing - calculating - distinguishing left and write
Autospy gold standard
Cholinesterase inhibitor; and antiparkinsonism drugs
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS

43. What mmse score suggest dementia
Acetylecholinersterase inhibitors
<20; if patient scores >25 benign forgetfulness
Myasthenia; due to autoantibodies against acetylecholine receptor;
Distal lower motor neuron disease

44. differentiate lewy body dementia and vascular dementia
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
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Not within 24 hours; give afte 24-48 hours if patient stable
Difficulty in writing - calculating - distinguishing left and write

45. dominant parietal lobe on the left side
90% of right handed and 60% of left handed persons; speech and language function
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Spastic paraparesis

46. GBS
Propranolol or primidone
IVIG and plasmapheresis
Autospy gold standard
Do CT scan at first to r/o SAH - if ct neg lumbar puncture

47. MMSE score of less than 24
Aphasia - neglect - agnosia - acalculia etc
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
82% specific for dementia

48. impaired perception of complex sounds
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Lesion in nondominant temporal lobe
Taper gradually to prevent seizure relapse
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure

49. How to differentiate parkinson and benign essential tremor
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Vitamin B12 deficiency
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
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

50. dementia plus urinary incontinence
Normal pressure hydrocephalus
IVIG and plasmapheresis
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate