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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. indication of plasmapheresis in GBS
<20; if patient scores >25 benign forgetfulness
Cerebellar lesion
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure

2. impaired perception of complex sounds
Taper gradually to prevent seizure relapse
Construction apraxia; lesion in non dominant parietal lobe (right)
Lesion in nondominant temporal lobe
Not within 24 hours; give afte 24-48 hours if patient stable

3. women with unilateral eye pain; neurlogic symptoms here there at different times
It patient has electrolyte imbalance and hypothermia
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
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
Cholinesterase inhibitor; and antiparkinsonism drugs

4. How to tx acute exacerbation of MS
Verapamil
High dose IV methyleprednisone;
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

5. How to differentiate medial and lateral pontine syndrome
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
20%
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
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

6. korsafoff psychosis
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Difficulty in writing - calculating - distinguishing left and write
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Spastic paraparesis

7. cortical lesion
Aphasia - neglect - agnosia - acalculia etc
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure

8. How to prevent prevent frequency of MS exacerbation
Taper gradually to prevent seizure relapse
Nystagmus on far lateral gaze
Upright supine position
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised

9. GBS
Coronary artery disease
IVIG and plasmapheresis
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel

10. lesion in dominant parietal lobe
Cerebellar lesion
<20; if patient scores >25 benign forgetfulness
Aspirin - control HTN and swallow eval before giving any oral meds
Difficulty in writing - calculating - distinguishing left and write

11. How to differentiate parkinson and benign essential tremor
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
Follows viral illness; vertigo - tinnitus - nausea. self limiting
High dose IV methyleprednisone;
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty

12. Acute onset of left arm weakness
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Tunnel vision - diaphoresis - nausea - pallor
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Diabetes insipidus

13. get up and go test
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Distal lower motor neuron disease
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

14. How to tx stroke patient came after 6h
Reduced efficacy of OCP
Aspirin - control HTN and swallow eval before giving any oral meds
Diabetes insipidus
IVIG and plasmapheresis

15. best diagnosis for parkinsonim
Diabetes insipidus
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
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

16. labyrinthitis
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
High dose IV methyleprednisone;
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Follows viral illness; vertigo - tinnitus - nausea. self limiting

17. How to diffrentiate tick borne paralysis from GBS and spinal cord tumor
Aspirin - control HTN and swallow eval before giving any oral meds
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Clonidine will take care both high bp and withdrawal

18. When to give aspirin when patient on tPA after stroke
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
<20; if patient scores >25 benign forgetfulness
Not within 24 hours; give afte 24-48 hours if patient stable
Aphasia - neglect - agnosia - acalculia etc

19. anerior and anteriomedial thigh paresthesia - decreased DTR
Tunnel vision - diaphoresis - nausea - pallor
Femoral n lesion
RBC count >6000
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy

20. 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
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure

21. When to use dopamine agonist pramipexol in parkinson
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
Not within 24 hours; give afte 24-48 hours if patient stable
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa

22. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Cerebral palsy; dx mri
Despite the term neuroma they arise from schwann cells - schwanoma
Acetylecholinersterase inhibitors

23. excessive elevation of legs during walking (toe touch floor earlier than heels)
Distal lower motor neuron disease
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Obturator n lesion
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;

24. What is can be used cluster headache prevention
Distal lower motor neuron disease
Deficit in cranial nerve function
Verapamil
Acetylecholinersterase inhibitors

25. When to use brain spect scintigraphy to confirm brain death
It patient has electrolyte imbalance and hypothermia
Autospy gold standard
Antitoxin
Normal pressure hydrocephalus

26. How to confirm braindeath?
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.
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
Upright supine position

27. drags leg forward in every steps - no knee flexion; hip flexion and straight legs
Spastic paraparesis
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
20%
Botulism has descending paralysis in contrast othere have ascending paralysis

28. stroke with lower facial palsy - pronator drift despite on aspirin
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Botulism has descending paralysis in contrast othere have ascending paralysis
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
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

29. How to differentiate medial and lateral medullary syndrome
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
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
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;
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;

30. patient with hx of cluster headache p/w retroorbital pain lacrimation - vomiting suddenly
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
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;
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Nystagmus on far lateral gaze

31. How to differentiate traumatic LP and SAH
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Tunnel vision - diaphoresis - nausea - pallor

32. 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
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Obturator n lesion
Vitamin B12 deficiency

33. earliest sign of phenytoin toxicity
MS
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Nystagmus on far lateral gaze
Lesion in nondominant temporal lobe

34. at first tingling in toes and feet then weakness in extremities
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
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure

35. hx of epilepsy - now unresponsive - slight twhiching of mouth and arms
Vitamin B12 deficiency
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Do CT scan at first to r/o SAH - if ct neg lumbar puncture

36. MG
Clonidine will take care both high bp and withdrawal
Acetylecholinersterase inhibitors
Lesion in nondominant temporal lobe
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty

37. How to differentiate botulism from tick born paralysis - GBS and MG
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
Botulism has descending paralysis in contrast othere have ascending paralysis
Gilberts disease
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure

38. brain stem lesion
Deficit in cranial nerve function
Cholinesterase inhibitor; and antiparkinsonism drugs
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Do CT scan at first to r/o SAH - if ct neg lumbar puncture

39. prodrome of vasovagal syncope
Tunnel vision - diaphoresis - nausea - pallor
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Autospy gold standard
Spastic paraparesis

40. Why V12 deficient develop hypokalemia after tx with b12
Cerebellar lesion
Difficulty in writing - calculating - distinguishing left and write
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Coronary artery disease

41. benign essential tremor
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
Construction apraxia; lesion in non dominant parietal lobe (right)
Propranolol or primidone
Femoral n lesion

42. How to manage stroke patient came within 4 hours
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
Acetylecholinersterase inhibitors
MS

43. What mmse score suggest dementia
Normal pressure hydrocephalus
Deficit in cranial nerve function
<20; if patient scores >25 benign forgetfulness
20%

44. infections in GBS
EPV - campylobacter - HSV
Get up from chair walk a short distance turn around and sit; screening test for fall
Taper gradually to prevent seizure relapse
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level

45. dominant parietal lobe on the left side
Autospy gold standard
Coronary artery disease
90% of right handed and 60% of left handed persons; speech and language function
Femoral n lesion

46. Patient with carbamazepine; What should be advice?
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Get up from chair walk a short distance turn around and sit; screening test for fall
Spastic paraparesis
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

47. How to stop antiepileptic drugs
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
Reduced efficacy of OCP
Construction apraxia; lesion in non dominant parietal lobe (right)
Taper gradually to prevent seizure relapse

48. differentiate lewy body dementia and vascular dementia
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
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
Cerebellar lesion

49. Should we tx htn in acute ischemic stroke

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50. acoustic neuroma
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Despite the term neuroma they arise from schwann cells - schwanoma
Normal pressure hydrocephalus
Propranolol or primidone