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. GBS
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Coronary artery 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
IVIG and plasmapheresis

2. What is pronator drift
90% of right handed and 60% of left handed persons; speech and language function
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
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.

3. How to tx lewy body dementia
Cholinesterase inhibitor; and antiparkinsonism drugs
Deficit in cranial nerve function
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
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal

4. How to differentiate botulism from tick born paralysis - GBS and MG
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
Botulism has descending paralysis in contrast othere have ascending paralysis
Antitoxin
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner

5. When to start fibrinolytic therapy in stroke patient?
Cholinesterase inhibitor; and antiparkinsonism drugs
Autospy gold standard
Diabetes insipidus
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge

6. How to manage stroke patient came within 4 hours
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
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
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica

7. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
Cerebral palsy; dx mri
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Aphasia - neglect - agnosia - acalculia etc

8. What percent of dementia is reversible
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
20%
Spastic paraparesis
Lesion in nondominant temporal lobe

9. stroke with lower facial palsy - pronator drift despite on aspirin
Antitoxin
Femoral n lesion
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
RBC count >6000

10. at first tingling in toes and feet then weakness in extremities
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Despite the term neuroma they arise from schwann cells - schwanoma
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica

11. lesion in dominant parietal lobe
Difficulty in writing - calculating - distinguishing left and write
Construction apraxia; lesion in non dominant parietal lobe (right)
20%
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l

12. double vision at the end of day and ptosis
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Femoral n lesion
Deficit in cranial nerve function
Myasthenia; due to autoantibodies against acetylecholine receptor;

13. When headache is presenting complaint of brain tumor
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
High dose IV methyleprednisone;
EPV - campylobacter - HSV
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening

14. How to diffrentiate tick borne paralysis from GBS and spinal cord tumor
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa

15. How to prevent prevent frequency of MS exacerbation
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.
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
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised

16. acoustic neuroma
Despite the term neuroma they arise from schwann cells - schwanoma
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
Taper gradually to prevent seizure relapse

17. benign essential tremor
Propranolol or primidone
RBC count >6000
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA

18. MG
Lesion in nondominant temporal lobe
Propranolol or primidone
Acetylecholinersterase inhibitors
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure

19. earliest sign of phenytoin toxicity
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Nystagmus on far lateral gaze
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
Construction apraxia; lesion in non dominant parietal lobe (right)

20. How to differentiate traumatic LP and SAH
Botulism has descending paralysis in contrast othere have ascending paralysis
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Aphasia - neglect - agnosia - acalculia etc
Taper gradually to prevent seizure relapse

21. 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
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Lesion in nondominant temporal lobe
Reduced efficacy of OCP

22. what drug is used to extend effects of levodopa
Entacapone - COMT inhibitor
Aphasia - neglect - agnosia - acalculia etc
Distal lower motor neuron disease
Taper gradually to prevent seizure relapse

23. How to perform apnea test
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
90% of right handed and 60% of left handed persons; speech and language function
EPV - campylobacter - HSV
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin

24. cortical lesion
RBC count >6000
Taper gradually to prevent seizure relapse
Aphasia - neglect - agnosia - acalculia etc
Botulism has descending paralysis in contrast othere have ascending paralysis

25. differentiate picks and huntington
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
Deficit in cranial nerve function
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

26. Blood transfusion in hypothermia
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
Taper gradually to prevent seizure relapse
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Cholinesterase inhibitor; and antiparkinsonism drugs

27. lesion in dominant tempora lobe
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
IVIG and plasmapheresis
Do CT scan at first to r/o SAH - if ct neg lumbar puncture

28. severe headache and high BP
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Despite the term neuroma they arise from schwann cells - schwanoma
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Do CT scan at first to r/o SAH - if ct neg lumbar puncture

29. impaired perception of complex sounds
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Lesion in nondominant temporal lobe
Botulism has descending paralysis in contrast othere have ascending paralysis
<20; if patient scores >25 benign forgetfulness

30. patient with hx of cluster headache p/w retroorbital pain lacrimation - vomiting suddenly
Taper gradually to prevent seizure relapse
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
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica

31. korsafoff psychosis
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
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
Corticosteroid and acyclovir
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement

32. Unable to copy of matchstick - unable to dress up
Construction apraxia; lesion in non dominant parietal lobe (right)
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
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
Deficit in cranial nerve function

33. Acute onset of left arm weakness
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;
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Autospy gold standard

34. indication of plasmapheresis in GBS
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
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
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening

35. oligoclonal band in CSF
Antitoxin
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
82% specific for dementia
MS

36. hx of epilepsy - now unresponsive - slight twhiching of mouth and arms
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
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
Deficit in cranial nerve function
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin

37. 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

38. How to stop antiepileptic drugs
Botulism has descending paralysis in contrast othere have ascending paralysis
Taper gradually to prevent seizure relapse
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised

39. labyrinthitis
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Taper gradually to prevent seizure relapse

40. How to tx stroke patient came after 6h
Spastic paraparesis
Normal pressure hydrocephalus
Aspirin - control HTN and swallow eval before giving any oral meds
High dose IV methyleprednisone;

41. How to differentiate medial and lateral pontine syndrome
Aspirin - control HTN and swallow eval before giving any oral meds
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
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Femoral n lesion

42. differentiate lewy body dementia and vascular dementia
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Propranolol or primidone
EPV - campylobacter - HSV
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

43. MMSE score of less than 24
Wernicke's encephalopathy; due to thiamine definition; medical emergency
82% specific for dementia
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

44. construction worker works in squatting position; now develop decreased sensation over anterolateral thigh
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
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;
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica

45. Most effective to reduce aspiration in stroke or patient with swallowing dysfunction
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Entacapone - COMT inhibitor
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Upright supine position

46. walking like drunken sailor; jerky hesitant and walks in zigzag pattern
Taper gradually to prevent seizure relapse
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Cerebellar lesion
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48

47. When to use dopamine agonist pramipexol in parkinson
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
EPV - campylobacter - HSV
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

48. best diagnosis for parkinsonim
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Not within 24 hours; give afte 24-48 hours if patient stable
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Autospy gold standard

49. How to tx acute exacerbation of MS
Cholinesterase inhibitor; and antiparkinsonism drugs
Despite the term neuroma they arise from schwann cells - schwanoma
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
High dose IV methyleprednisone;

50. impaired vibration and increased DTR
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Deficit in cranial nerve function
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.
Vitamin B12 deficiency