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. How to tx lewy body dementia
Cholinesterase inhibitor; and antiparkinsonism drugs
Coronary artery disease
Vitamin B12 deficiency
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge

2. How to confirm braindeath?
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
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.
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
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;

3. When headache is presenting complaint of brain tumor
<20; if patient scores >25 benign forgetfulness
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Diabetes insipidus

4. indication of plasmapheresis in GBS
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;
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
RBC count >6000
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure

5. When to use brain spect scintigraphy to confirm brain death
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
Not within 24 hours; give afte 24-48 hours if patient stable
It patient has electrolyte imbalance and hypothermia
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner

6. excessive elevation of legs during walking (toe touch floor earlier than heels)
Distal lower motor neuron disease
Botulism has descending paralysis in contrast othere have ascending paralysis
Taper gradually to prevent seizure relapse
Propranolol or primidone

7. best diagnosis for parkinsonim
Verapamil
Autospy gold standard
90% of right handed and 60% of left handed persons; speech and language function
82% specific for dementia

8. get up and go test
Upright supine position
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.
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
Get up from chair walk a short distance turn around and sit; screening test for fall

9. medial thigh sensory loss and weakness in addcution
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
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
Obturator n lesion

10. double vision at the end of day and ptosis
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Not within 24 hours; give afte 24-48 hours if patient stable
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
Myasthenia; due to autoantibodies against acetylecholine receptor;

11. brain stem lesion
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.
Deficit in cranial nerve function
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
90% of right handed and 60% of left handed persons; speech and language function

12. what drug is used to extend effects of levodopa
Myasthenia; due to autoantibodies against acetylecholine receptor;
Entacapone - COMT inhibitor
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.
Upright supine position

13. craniopharyngioma
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
Diabetes insipidus
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Spastic paraparesis

14. What is can be used cluster headache prevention
Myasthenia; due to autoantibodies against acetylecholine receptor;
Obturator n lesion
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
Verapamil

15. dominant parietal lobe on the left side
90% of right handed and 60% of left handed persons; speech and language function
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa

16. What percent of dementia is reversible
Antitoxin
Tunnel vision - diaphoresis - nausea - pallor
20%
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test

17. at first tingling in toes and feet then weakness in extremities
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Get up from chair walk a short distance turn around and sit; screening test for fall
Antitoxin

18. patient with hx of cluster headache p/w retroorbital pain lacrimation - vomiting suddenly
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
Acetylecholinersterase inhibitors
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate

19. stroke with lower facial palsy - pronator drift despite on aspirin
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Construction apraxia; lesion in non dominant parietal lobe (right)
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%

20. botulism
Get up from chair walk a short distance turn around and sit; screening test for fall
Antitoxin
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Cerebellar lesion

21. contraindication of sumatripta
Autospy gold standard
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Coronary artery disease
Construction apraxia; lesion in non dominant parietal lobe (right)

22. How to manage stroke patient came within 4 hours
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.
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
Acetylecholinersterase inhibitors
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure

23. Patient with carbamazepine; What should be advice?
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
20%
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
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

24. how donepezil - acetylecholinsterase inhibitor works in Alzheimers
Coronary artery disease
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Taper gradually to prevent seizure relapse
Gilberts disease

25. headache - non reactive pupil - fall on both sides during walking - impaired upward gaze
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
IVIG and plasmapheresis
Deficit in cranial nerve function
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty

26. How to differentiate botulism from tick born paralysis - GBS and MG
20%
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.
Botulism has descending paralysis in contrast othere have ascending paralysis

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

28. Why V12 deficient develop hypokalemia after tx with b12
Nystagmus on far lateral gaze
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
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

29. lesion in dominant parietal lobe
Difficulty in writing - calculating - distinguishing left and write
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
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
Cholinesterase inhibitor; and antiparkinsonism drugs

30. What is pronator drift
Gilberts disease
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
Aspirin - control HTN and swallow eval before giving any oral meds
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

31. How to differentiate parkinson and benign essential tremor
90% of right handed and 60% of left handed persons; speech and language function
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Wernicke's encephalopathy; due to thiamine definition; medical emergency
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

32. impaired perception of complex sounds
Get up from chair walk a short distance turn around and sit; screening test for fall
Lesion in nondominant temporal lobe
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
90% of right handed and 60% of left handed persons; speech and language function

33. women with unilateral eye pain; neurlogic symptoms here there at different times
90% of right handed and 60% of left handed persons; speech and language function
High dose IV methyleprednisone;
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS

34. Unable to copy of matchstick - unable to dress up
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
Construction apraxia; lesion in non dominant parietal lobe (right)
90% of right handed and 60% of left handed persons; speech and language function
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS

35. impaired hepatic conjugation of billirubin
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
IVIG and plasmapheresis
Gilberts disease
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

36. acoustic neuroma
Normal pressure hydrocephalus
Botulism has descending paralysis in contrast othere have ascending paralysis
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Despite the term neuroma they arise from schwann cells - schwanoma

37. When to give aspirin when patient on tPA after stroke
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
EPV - campylobacter - HSV
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Not within 24 hours; give afte 24-48 hours if patient stable

38. alcoholic p/w confusion - ataxia - tremor - nystamgus

39. Blood transfusion in hypothermia
Myasthenia; due to autoantibodies against acetylecholine receptor;
Reduced efficacy of OCP
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate

40. How to diffrentiate tick borne paralysis from GBS and spinal cord tumor
Nystagmus on far lateral gaze
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Upright supine position
Aspirin - control HTN and swallow eval before giving any oral meds

41. anerior and anteriomedial thigh paresthesia - decreased DTR
Femoral n lesion
IVIG and plasmapheresis
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
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised

42. 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
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Lesion in nondominant temporal lobe
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID

43. dementia plus urinary incontinence
Normal pressure hydrocephalus
Aphasia - neglect - agnosia - acalculia etc
Spastic paraparesis
Tunnel vision - diaphoresis - nausea - pallor

44. cortical lesion
Aphasia - neglect - agnosia - acalculia etc
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
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
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA

45. benign essential tremor
Propranolol or primidone
Lesion in nondominant temporal lobe
Antitoxin
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel

46. How to stop antiepileptic drugs
Nystagmus on far lateral gaze
RBC count >6000
Taper gradually to prevent seizure relapse
Entacapone - COMT inhibitor

47. hx of epilepsy - now unresponsive - slight twhiching of mouth and arms
Antitoxin
Spastic paraparesis
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
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin

48. labyrinthitis
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
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
Follows viral illness; vertigo - tinnitus - nausea. self limiting

49. How to differentiate dementias
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
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

50. How to prevent prevent frequency of MS exacerbation
Upright supine position
Spastic paraparesis
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate