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 mmse score suggest dementia
Difficulty in writing - calculating - distinguishing left and write
Tunnel vision - diaphoresis - nausea - pallor
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
<20; if patient scores >25 benign forgetfulness

2. When to suspect traumatic LP
Myasthenia; due to autoantibodies against acetylecholine receptor;
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
RBC count >6000
Propranolol or primidone

3. at first tingling in toes and feet then weakness in extremities
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;
Reduced efficacy of OCP
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
MS

4. infections in GBS
Upright supine position
EPV - campylobacter - HSV
It patient has electrolyte imbalance and hypothermia
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel

5. What is can be used cluster headache prevention
MS
Verapamil
Propranolol or primidone
Despite the term neuroma they arise from schwann cells - schwanoma

6. When headache is presenting complaint of brain tumor
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Clonidine will take care both high bp and withdrawal
Get up from chair walk a short distance turn around and sit; screening test for fall
Myasthenia; due to autoantibodies against acetylecholine receptor;

7. How to prevent prevent frequency of MS exacerbation
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Upright supine position
Construction apraxia; lesion in non dominant parietal lobe (right)

8. 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
IVIG and plasmapheresis
Clonidine will take care both high bp and withdrawal

9. How to tx acute exacerbation of 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
High dose IV methyleprednisone;
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
Vitamin B12 deficiency

10. cluster headache
Aphasia - neglect - agnosia - acalculia etc
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
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

11. excessive elevation of legs during walking (toe touch floor earlier than heels)
Clonidine will take care both high bp and withdrawal
Taper gradually to prevent seizure relapse
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Distal lower motor neuron disease

12. severe headache and high BP
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Despite the term neuroma they arise from schwann cells - schwanoma

13. 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
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
IVIG and plasmapheresis
Aspirin - control HTN and swallow eval before giving any oral meds

14. When to give aspirin when patient on tPA after stroke
Not within 24 hours; give afte 24-48 hours if patient stable
Spastic paraparesis
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
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

15. How to tx lewy body dementia
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;
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.
Cholinesterase inhibitor; and antiparkinsonism drugs
Tunnel vision - diaphoresis - nausea - pallor

16. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
Diabetes insipidus
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;
Cerebral palsy; dx mri
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa

17. craniopharyngioma
Diabetes insipidus
Aphasia - neglect - agnosia - acalculia etc
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Autospy gold standard

18. When to start fibrinolytic therapy in stroke patient?
Femoral n lesion
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa

19. How to differentiate botulism from tick born paralysis - GBS and MG
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
Spastic paraparesis
Nystagmus on far lateral gaze

20. impaired vibration and increased DTR
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Vitamin B12 deficiency
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Propranolol or primidone

21. cortical lesion
Aphasia - neglect - agnosia - acalculia etc
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;
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel

22. When to use brain spect scintigraphy to confirm brain death
It patient has electrolyte imbalance and hypothermia
Construction apraxia; lesion in non dominant parietal lobe (right)
MS
Distal lower motor neuron disease

23. best diagnosis for parkinsonim
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
Vitamin B12 deficiency
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
Autospy gold standard

24. double vision at the end of day and ptosis
Spastic paraparesis
EPV - campylobacter - HSV
Botulism has descending paralysis in contrast othere have ascending paralysis
Myasthenia; due to autoantibodies against acetylecholine receptor;

25. What percent of dementia is reversible
Not within 24 hours; give afte 24-48 hours if patient stable
Upright supine position
20%
Vitamin B12 deficiency

26. drags leg forward in every steps - no knee flexion; hip flexion and straight legs
Clonidine will take care both high bp and withdrawal
Normal pressure hydrocephalus
Femoral n lesion
Spastic paraparesis

27. medial thigh sensory loss and weakness in addcution
EPV - campylobacter - HSV
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
Obturator n lesion
20%

28. what drug is used to extend effects of levodopa
Entacapone - COMT inhibitor
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
EPV - campylobacter - HSV
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa

29. What is pronator drift
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Spastic paraparesis
Lesion in nondominant temporal lobe
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

30. benign essential tremor
Get up from chair walk a short distance turn around and sit; screening test for fall
It patient has electrolyte imbalance and hypothermia
Myasthenia; due to autoantibodies against acetylecholine receptor;
Propranolol or primidone

31. Unable to copy of matchstick - unable to dress up
Construction apraxia; lesion in non dominant parietal lobe (right)
Tunnel vision - diaphoresis - nausea - pallor
Entacapone - COMT inhibitor
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test

32. How to differentiate traumatic LP and SAH
Gilberts disease
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
Lesion in nondominant temporal lobe
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH

33. MMSE score of less than 24
Construction apraxia; lesion in non dominant parietal lobe (right)
Reduced efficacy of OCP
Aphasia - neglect - agnosia - acalculia etc
82% specific for dementia

34. earliest sign of phenytoin toxicity
Nystagmus on far lateral gaze
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
MS

35. 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
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Not within 24 hours; give afte 24-48 hours if patient stable
Difficulty in writing - calculating - distinguishing left and write

36. 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
Normal pressure hydrocephalus
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
Propranolol or primidone

37. Acute onset of left arm weakness
Normal pressure hydrocephalus
Femoral n lesion
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Wernicke's encephalopathy; due to thiamine definition; medical emergency

38. patient with hx of cluster headache p/w retroorbital pain lacrimation - vomiting suddenly
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
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Spastic paraparesis
82% specific for dementia

39. dominant parietal lobe on the left side
Aspirin - control HTN and swallow eval before giving any oral meds
Get up from chair walk a short distance turn around and sit; screening test for fall
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
90% of right handed and 60% of left handed persons; speech and language function

40. prodrome of vasovagal syncope
Propranolol or primidone
Tunnel vision - diaphoresis - nausea - pallor
Aphasia - neglect - agnosia - acalculia etc
Cerebral palsy; dx mri

41. phenytoin and OCP
Get up from chair walk a short distance turn around and sit; screening test for fall
Coronary artery disease
High dose IV methyleprednisone;
Reduced efficacy of OCP

42. labyrinthitis
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Coronary artery disease
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

43. How to stop antiepileptic drugs
Aphasia - neglect - agnosia - acalculia etc
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Diabetes insipidus
Taper gradually to prevent seizure relapse

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

45. women with unilateral eye pain; neurlogic symptoms here there at different times
<20; if patient scores >25 benign forgetfulness
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;
Despite the term neuroma they arise from schwann cells - schwanoma
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS

46. how donepezil - acetylecholinsterase inhibitor works in Alzheimers
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Propranolol or primidone
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Clonidine will take care both high bp and withdrawal

47. Why V12 deficient develop hypokalemia after tx with b12
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Lesion in nondominant temporal lobe
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

48. Tx of bells palsy
Corticosteroid and acyclovir
Propranolol or primidone
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
MS

49. What bp med to be given in a patient with high bp and signs of opioid withdrawal
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Clonidine will take care both high bp and withdrawal
Deficit in cranial nerve function
Spastic paraparesis

50. oligoclonal band in CSF
Gilberts disease
Get up from chair walk a short distance turn around and sit; screening test for fall
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
MS