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. Why V12 deficient develop hypokalemia after tx with b12
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
High dose IV methyleprednisone;

2. 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

3. construction worker works in squatting position; now develop decreased sensation over anterolateral thigh
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
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.
Taper gradually to prevent seizure relapse
It patient has electrolyte imbalance and hypothermia

4. How to differentiate medial and lateral medullary syndrome
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;
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
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
MS

5. How to differentiate traumatic LP and SAH
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Distal lower motor neuron disease
Spastic paraparesis
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement

6. How to differentiate botulism from tick born paralysis - GBS and MG
Get up from chair walk a short distance turn around and sit; screening test for fall
It patient has electrolyte imbalance and hypothermia
Obturator n lesion
Botulism has descending paralysis in contrast othere have ascending paralysis

7. 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

8. How to tx acute exacerbation of MS
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Verapamil
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
High dose IV methyleprednisone;

9. How to prevent prevent frequency of MS exacerbation
Cerebral palsy; dx mri
Lesion in nondominant temporal lobe
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Cholinesterase inhibitor; and antiparkinsonism drugs

10. How to stop antiepileptic drugs
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
Verapamil
Taper gradually to prevent seizure relapse
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal

11. earliest sign of phenytoin toxicity
20%
Deficit in cranial nerve function
Lesion in nondominant temporal lobe
Nystagmus on far lateral gaze

12. anerior and anteriomedial thigh paresthesia - decreased DTR
Femoral n lesion
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
Cholinesterase inhibitor; and antiparkinsonism drugs

13. Tx of GBS
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Entacapone - COMT inhibitor
<20; if patient scores >25 benign forgetfulness
20%

14. best diagnosis for parkinsonim
Cerebral palsy; dx mri
Autospy gold standard
Botulism has descending paralysis in contrast othere have ascending paralysis
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure

15. Unable to copy of matchstick - unable to dress up
Construction apraxia; lesion in non dominant parietal lobe (right)
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Not within 24 hours; give afte 24-48 hours if patient stable

16. indication of plasmapheresis in GBS
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
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Normal pressure hydrocephalus
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure

17. 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
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
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
Follows viral illness; vertigo - tinnitus - nausea. self limiting

18. cortical lesion
Botulism has descending paralysis in contrast othere have ascending paralysis
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Aphasia - neglect - agnosia - acalculia etc
Femoral n lesion

19. headache - non reactive pupil - fall on both sides during walking - impaired upward gaze
Cerebellar lesion
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
EPV - campylobacter - HSV
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty

20. What is pronator drift
Taper gradually to prevent seizure relapse
Obturator n lesion
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

21. How to tx lewy body dementia
Cholinesterase inhibitor; and antiparkinsonism drugs
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.
Verapamil
Spastic paraparesis

22. excessive elevation of legs during walking (toe touch floor earlier than heels)
Distal lower motor neuron disease
Obturator n lesion
Antitoxin
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge

23. differentiate wenicke and korsakoff
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 in alcoholic; wernicke develop at first with horizontal nystagmus - and ataxia; if not treated they develop memory loss and psychosis which is named korsakoff
Lesion in nondominant temporal lobe
Reduced efficacy of OCP

24. double vision at the end of day and ptosis
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
MS
Myasthenia; due to autoantibodies against acetylecholine receptor;
Lesion in nondominant temporal lobe

25. how donepezil - acetylecholinsterase inhibitor works in Alzheimers
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
IVIG and plasmapheresis
It patient has electrolyte imbalance and hypothermia
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level

26. What mmse score suggest dementia
Propranolol or primidone
Acetylecholinersterase inhibitors
90% of right handed and 60% of left handed persons; speech and language function
<20; if patient scores >25 benign forgetfulness

27. impaired perception of complex sounds
Aspirin - control HTN and swallow eval before giving any oral meds
Deficit in cranial nerve function
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Lesion in nondominant temporal lobe

28. differentiate picks and huntington
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
<20; if patient scores >25 benign forgetfulness
Femoral n lesion
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l

29. Acute onset of left arm weakness
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Difficulty in writing - calculating - distinguishing left and write
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure

30. How to differentiate parkinson and benign essential tremor
Corticosteroid and acyclovir
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
Difficulty in writing - calculating - distinguishing left and write
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. phenytoin and OCP
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;
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
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate

32. stroke with lower facial palsy - pronator drift despite on aspirin
Get up from chair walk a short distance turn around and sit; screening test for fall
Obturator n lesion
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
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel

33. dementia plus urinary incontinence
Antitoxin
Obturator n lesion
Normal pressure hydrocephalus
Follows viral illness; vertigo - tinnitus - nausea. self limiting

34. MMSE score of less than 24
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Obturator n lesion
82% specific for dementia
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

35. differentiate lewy body dementia and vascular dementia
Acetylecholinersterase inhibitors
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
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
90% of right handed and 60% of left handed persons; speech and language function

36. How to differentiate dementias
EPV - campylobacter - HSV
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)
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l

37. craniopharyngioma
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Distal lower motor neuron disease
Diabetes insipidus
Coronary artery disease

38. labyrinthitis
IVIG and plasmapheresis
Spastic paraparesis
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Aphasia - neglect - agnosia - acalculia etc

39. infections in GBS
EPV - campylobacter - HSV
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Propranolol or primidone
Do CT scan at first to r/o SAH - if ct neg lumbar puncture

40. When to use dopamine agonist pramipexol in parkinson
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Propranolol or primidone
Wernicke's encephalopathy; due to thiamine definition; medical emergency
<20; if patient scores >25 benign forgetfulness

41. dominant parietal lobe on the left side
Cholinesterase inhibitor; and antiparkinsonism drugs
Obturator n lesion
90% of right handed and 60% of left handed persons; speech and language function
20%

42. lesion in dominant parietal lobe
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
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
Spastic paraparesis

43. Patient with carbamazepine; What should be advice?
Taper gradually to prevent seizure relapse
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
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
Aphasia - neglect - agnosia - acalculia etc

44. what drug is used to extend effects of levodopa
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Entacapone - COMT inhibitor
Upright supine position
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy

45. cluster headache
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
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

46. How to confirm braindeath?
Not within 24 hours; give afte 24-48 hours if patient stable
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.
Coronary artery disease
Tunnel vision - diaphoresis - nausea - pallor

47. walking like drunken sailor; jerky hesitant and walks in zigzag pattern
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Lesion in nondominant temporal lobe
Cerebellar lesion
Taper gradually to prevent seizure relapse

48. How to differentiate medial and lateral pontine syndrome
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
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
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Verapamil

49. What bp med to be given in a patient with high bp and signs of opioid withdrawal
Reduced efficacy of OCP
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Clonidine will take care both high bp and withdrawal
82% specific for dementia

50. acoustic neuroma
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
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
Femoral n lesion
Despite the term neuroma they arise from schwann cells - schwanoma