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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. differentiate wenicke and korsakoff
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
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
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

2. medial thigh sensory loss and weakness in addcution
IVIG and plasmapheresis
Obturator n lesion
Tunnel vision - diaphoresis - nausea - pallor
Follows viral illness; vertigo - tinnitus - nausea. self limiting

3. construction worker works in squatting position; now develop decreased sensation over anterolateral thigh
90% of right handed and 60% of left handed persons; speech and language function
Cerebellar lesion
Get up from chair walk a short distance turn around and sit; screening test for fall
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica

4. hx of epilepsy - now unresponsive - slight twhiching of mouth and arms
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Not within 24 hours; give afte 24-48 hours if patient stable
Obturator n lesion

5. how donepezil - acetylecholinsterase inhibitor works in Alzheimers
82% specific for dementia
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
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.
Spastic paraparesis

6. what drug is used to extend effects of levodopa
Propranolol or primidone
Not within 24 hours; give afte 24-48 hours if patient stable
Entacapone - COMT inhibitor
Follows viral illness; vertigo - tinnitus - nausea. self limiting

7. 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
90% of right handed and 60% of left handed persons; speech and language function
Autospy gold standard
Not within 24 hours; give afte 24-48 hours if patient stable

8. cluster headache
Aphasia - neglect - agnosia - acalculia etc
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
Despite the term neuroma they arise from schwann cells - schwanoma
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening

9. How to prevent prevent frequency of MS exacerbation
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
High dose IV methyleprednisone;
Cerebral palsy; dx mri
Propranolol or primidone

10. How to differentiate botulism from tick born paralysis - GBS and MG
Botulism has descending paralysis in contrast othere have ascending paralysis
Clonidine will take care both high bp and withdrawal
Aspirin - control HTN and swallow eval before giving any oral meds
Wernicke's encephalopathy; due to thiamine definition; medical emergency

11. How to tx stroke patient came after 6h
Deficit in cranial nerve function
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
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

12. craniopharyngioma
Deficit in cranial nerve function
Diabetes insipidus
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
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy

13. MG
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
Coronary artery disease
Acetylecholinersterase inhibitors
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;

14. What bp med to be given in a patient with high bp and signs of opioid withdrawal
Clonidine will take care both high bp and withdrawal
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.
IVIG and plasmapheresis
90% of right handed and 60% of left handed persons; speech and language function

15. benign essential tremor
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Propranolol or primidone
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.
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening

16. impaired perception of complex sounds
Upright supine position
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
<20; if patient scores >25 benign forgetfulness
Lesion in nondominant temporal lobe

17. How to stop antiepileptic drugs
Taper gradually to prevent seizure relapse
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
EPV - campylobacter - HSV

18. What is pronator drift
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
Upright supine position
Autospy gold standard
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

19. contraindication of sumatripta
Botulism has descending paralysis in contrast othere have ascending paralysis
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;
Coronary artery disease
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

20. Acute onset of left arm weakness
Distal lower motor neuron disease
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Construction apraxia; lesion in non dominant parietal lobe (right)
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge

21. phenytoin and OCP
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
Femoral n lesion
IVIG and plasmapheresis

22. get up and go test
Despite the term neuroma they arise from schwann cells - schwanoma
Get up from chair walk a short distance turn around and sit; screening test for fall
Myasthenia; due to autoantibodies against acetylecholine receptor;
Verapamil

23. Tx of GBS
EPV - campylobacter - HSV
Normal pressure hydrocephalus
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel

24. impaired hepatic conjugation of billirubin
Reduced efficacy of OCP
Gilberts disease
Propranolol or primidone
Antitoxin

25. drags leg forward in every steps - no knee flexion; hip flexion and straight legs
Spastic paraparesis
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Diabetes insipidus
Wernicke's encephalopathy; due to thiamine definition; medical emergency

26. lesion in dominant parietal lobe
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Difficulty in writing - calculating - distinguishing left and write
Propranolol or primidone
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure

27. walking like drunken sailor; jerky hesitant and walks in zigzag pattern
Cerebellar lesion
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Gilberts disease

28. Patient with carbamazepine; What should be advice?
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
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

29. Unable to copy of matchstick - unable to dress up
Lesion in nondominant temporal lobe
RBC count >6000
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Construction apraxia; lesion in non dominant parietal lobe (right)

30. oligoclonal band in CSF
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
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Entacapone - COMT inhibitor
MS

31. How to manage stroke patient came within 4 hours
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
20%
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;

32. How to tx lewy body dementia
Distal lower motor neuron disease
Get up from chair walk a short distance turn around and sit; screening test for fall
Cholinesterase inhibitor; and antiparkinsonism drugs
Follows viral illness; vertigo - tinnitus - nausea. self limiting

33. excessive elevation of legs during walking (toe touch floor earlier than heels)
Distal lower motor neuron disease
20%
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Vitamin B12 deficiency

34. acoustic neuroma
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
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Myasthenia; due to autoantibodies against acetylecholine receptor;
Despite the term neuroma they arise from schwann cells - schwanoma

35. women with unilateral eye pain; neurlogic symptoms here there at different times
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Autospy gold standard
IVIG and plasmapheresis

36. headache - non reactive pupil - fall on both sides during walking - impaired upward gaze
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
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
20%
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;

37. lesion in dominant tempora lobe
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Construction apraxia; lesion in non dominant parietal lobe (right)
Nystagmus on far lateral gaze

38. How to differentiate medial and lateral medullary syndrome
Reduced efficacy of OCP
Obturator n lesion
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
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;

39. How to diffrentiate tick borne paralysis from GBS and spinal cord tumor
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
20%
Entacapone - COMT inhibitor

40. anerior and anteriomedial thigh paresthesia - decreased DTR
20%
Aphasia - neglect - agnosia - acalculia etc
Femoral n lesion
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

41. MMSE score of less than 24
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
82% specific for dementia
Nystagmus on far lateral gaze
Difficulty in writing - calculating - distinguishing left and write

42. How to differentiate traumatic LP and SAH
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Spastic paraparesis
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
EPV - campylobacter - HSV

43. patient with hx of cluster headache p/w retroorbital pain lacrimation - vomiting suddenly
Acetylecholinersterase inhibitors
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Do CT scan at first to r/o SAH - if ct neg lumbar puncture

44. stroke with lower facial palsy - pronator drift despite on aspirin
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
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
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa

45. earliest sign of phenytoin toxicity
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Nystagmus on far lateral gaze
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
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

46. cortical lesion
Aphasia - neglect - agnosia - acalculia etc
RBC count >6000
Autospy gold standard
Do CT scan at first to r/o SAH - if ct neg lumbar puncture

47. How to differentiate medial and lateral pontine syndrome
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
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

48. When to suspect traumatic LP
RBC count >6000
Vitamin B12 deficiency
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
90% of right handed and 60% of left handed persons; speech and language function

49. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
Aphasia - neglect - agnosia - acalculia etc
Cerebral palsy; dx mri
Get up from chair walk a short distance turn around and sit; screening test for fall
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l

50. severe headache and high BP
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
20%
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate