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. What is can be used cluster headache prevention
Verapamil
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
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 develop fever - mouth ulcer - easy brusing - petechie - see a doc ; the drug cause neutropenia - and bone marrow suppression; elderly are at risk of SIADH

2. headache - non reactive pupil - fall on both sides during walking - impaired upward gaze
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Autospy gold standard
Distal lower motor neuron disease
Deficit in cranial nerve function

3. impaired perception of complex sounds
Femoral n lesion
Not within 24 hours; give afte 24-48 hours if patient stable
Lesion in nondominant temporal lobe
Nystagmus on far lateral gaze

4. differentiate lewy body dementia and vascular dementia
MS
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
Coronary artery disease
Despite the term neuroma they arise from schwann cells - schwanoma

5. When to use brain spect scintigraphy to confirm brain death
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Aphasia - neglect - agnosia - acalculia etc
It patient has electrolyte imbalance and hypothermia
Verapamil

6. Blood transfusion in hypothermia
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
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
Femoral n lesion

7. contraindication of sumatripta
Spastic paraparesis
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Coronary artery disease
Cerebral palsy; dx mri

8. labyrinthitis
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica

9. Tx of bells palsy
Not within 24 hours; give afte 24-48 hours if patient stable
Corticosteroid and acyclovir
Distal lower motor neuron disease
<20; if patient scores >25 benign forgetfulness

10. botulism
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Antitoxin
Reduced efficacy of OCP
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge

11. 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
Gilberts disease
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Get up from chair walk a short distance turn around and sit; screening test for fall

12. korsafoff psychosis
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
Obturator n lesion
High dose IV methyleprednisone;
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement

13. Most effective to reduce aspiration in stroke or patient with swallowing dysfunction
Spastic paraparesis
Upright supine position
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
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa

14. oligoclonal band in CSF
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Propranolol or primidone
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
MS

15. double vision at the end of day and ptosis
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Spastic paraparesis
Cerebellar lesion
Myasthenia; due to autoantibodies against acetylecholine receptor;

16. dominant parietal lobe on the left side
Lesion in nondominant temporal lobe
Acetylecholinersterase inhibitors
Coronary artery disease
90% of right handed and 60% of left handed persons; speech and language function

17. impaired hepatic conjugation of billirubin
Gilberts 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
Obturator n lesion
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

18. MMSE score of less than 24
82% specific for dementia
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
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.
Cerebellar lesion

19. earliest sign of phenytoin toxicity
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
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Nystagmus on far lateral gaze
Lesion in nondominant temporal lobe

20. drags leg forward in every steps - no knee flexion; hip flexion and straight legs
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
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
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner

21. best diagnosis for parkinsonim
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Difficulty in writing - calculating - distinguishing left and write
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Autospy gold standard

22. 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
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
Acetylecholinersterase inhibitors
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

23. 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
<20; if patient scores >25 benign forgetfulness
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Do CT scan at first to r/o SAH - if ct neg lumbar puncture

24. anerior and anteriomedial thigh paresthesia - decreased DTR
MS
Femoral n lesion
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
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.

25. 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

26. severe headache and high BP
Cerebral palsy; dx mri
Cholinesterase inhibitor; and antiparkinsonism drugs
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal

27. indication of plasmapheresis in GBS
It patient has electrolyte imbalance and hypothermia
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Verapamil

28. Why V12 deficient develop hypokalemia after tx with b12
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Aspirin - control HTN and swallow eval before giving any oral meds

29. How to prevent prevent frequency of MS exacerbation
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
82% specific for dementia
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
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

30. walking like drunken sailor; jerky hesitant and walks in zigzag pattern
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;
Cerebellar lesion
20%
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.

31. Tx of GBS
Spontaneous remission; admit if suspected and monitor pulse ox for 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
Not within 24 hours; give afte 24-48 hours if patient stable
Get up from chair walk a short distance turn around and sit; screening test for fall

32. Patient with carbamazepine; What should be advice?
Cerebral palsy; dx mri
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
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

33. GBS
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Clonidine will take care both high bp and withdrawal
IVIG and plasmapheresis
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy

34. brain stem lesion
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Not within 24 hours; give afte 24-48 hours if patient stable
Deficit in cranial nerve function
90% of right handed and 60% of left handed persons; speech and language function

35. How to differentiate botulism from tick born paralysis - GBS and MG
Botulism has descending paralysis in contrast othere have ascending paralysis
Cholinesterase inhibitor; and antiparkinsonism drugs
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Tunnel vision - diaphoresis - nausea - pallor

36. what drug is used to extend effects of levodopa
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Entacapone - COMT inhibitor
MS

37. How to tx stroke patient came after 6h
Coronary artery disease
Aspirin - control HTN and swallow eval before giving any oral meds
90% of right handed and 60% of left handed persons; speech and language function
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;

38. impaired vibration and increased DTR
Cholinesterase inhibitor; and antiparkinsonism drugs
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Vitamin B12 deficiency
Lesion in nondominant temporal lobe

39. What mmse score suggest dementia
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Coronary artery disease
<20; if patient scores >25 benign forgetfulness
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH

40. craniopharyngioma
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Diabetes insipidus
EPV - campylobacter - HSV
Difficulty in writing - calculating - distinguishing left and write

41. medial thigh sensory loss and weakness in addcution
Obturator n lesion
Reduced efficacy of OCP
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
Taper gradually to prevent seizure relapse

42. benign essential tremor
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Propranolol or primidone
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
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

43. 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

44. how donepezil - acetylecholinsterase inhibitor works in Alzheimers
Corticosteroid and acyclovir
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
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Nystagmus on far lateral gaze

45. dementia plus urinary incontinence
Normal pressure hydrocephalus
Distal lower motor neuron disease
Antitoxin
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure

46. How to manage stroke patient came within 4 hours
82% specific for dementia
It patient has electrolyte imbalance and hypothermia
Myasthenia; due to autoantibodies against acetylecholine receptor;
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;

47. excessive elevation of legs during walking (toe touch floor earlier than heels)
Distal lower motor neuron disease
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Reduced efficacy of OCP
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure

48. How to tx lewy body dementia
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
Coronary artery disease

49. at first tingling in toes and feet then weakness in extremities
Entacapone - COMT inhibitor
90% of right handed and 60% of left handed persons; speech and language function
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica

50. What percent of dementia is reversible
Nystagmus on far lateral gaze
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
20%
Follows viral illness; vertigo - tinnitus - nausea. self limiting