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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. Tx of GBS
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
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
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure

2. medial thigh sensory loss and weakness in addcution
Obturator n lesion
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Taper gradually to prevent seizure relapse
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

3. lesion in dominant tempora lobe
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Aspirin - control HTN and swallow eval before giving any oral meds
Spastic paraparesis
82% specific for dementia

4. differentiate picks and huntington
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
<20; if patient scores >25 benign forgetfulness
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

5. double vision at the end of day and ptosis
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Myasthenia; due to autoantibodies against acetylecholine receptor;

6. earliest sign of phenytoin toxicity
<20; if patient scores >25 benign forgetfulness
Upright supine position
Get up from chair walk a short distance turn around and sit; screening test for fall
Nystagmus on far lateral gaze

7. botulism
Clonidine will take care both high bp and withdrawal
Difficulty in writing - calculating - distinguishing left and write
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Antitoxin

8. What bp med to be given in a patient with high bp and signs of opioid withdrawal
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
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
Clonidine will take care both high bp and withdrawal
Cholinesterase inhibitor; and antiparkinsonism drugs

9. acoustic neuroma
Normal pressure hydrocephalus
Despite the term neuroma they arise from schwann cells - schwanoma
Tunnel vision - diaphoresis - nausea - pallor
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

10. construction worker works in squatting position; now develop decreased sensation over anterolateral thigh
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
Difficulty in writing - calculating - distinguishing left and write
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure

11. MMSE score of less than 24
Reduced efficacy of OCP
Aspirin - control HTN and swallow eval before giving any oral meds
Cerebellar lesion
82% specific for dementia

12. cortical lesion
Distal lower motor neuron disease
Difficulty in writing - calculating - distinguishing left and write
Tunnel vision - diaphoresis - nausea - pallor
Aphasia - neglect - agnosia - acalculia etc

13. How to tx lewy body dementia
90% of right handed and 60% of left handed persons; speech and language function
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Reduced efficacy of OCP
Cholinesterase inhibitor; and antiparkinsonism drugs

14. What is can be used cluster headache prevention
IVIG and plasmapheresis
82% specific for dementia
Verapamil
Clonidine will take care both high bp and withdrawal

15. severe headache and high BP
Normal pressure hydrocephalus
Nystagmus on far lateral gaze
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level

16. How to tx stroke patient came after 6h
Entacapone - COMT inhibitor
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Normal pressure hydrocephalus
Aspirin - control HTN and swallow eval before giving any oral meds

17. infections in GBS
Reduced efficacy of OCP
Corticosteroid and acyclovir
EPV - campylobacter - HSV
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID

18. When to use dopamine agonist pramipexol in parkinson
Antitoxin
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Femoral n lesion
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa

19. get up and go test
Vitamin B12 deficiency
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Get up from chair walk a short distance turn around and sit; screening test for fall

20. What percent of dementia is reversible
Cerebellar lesion
Normal pressure hydrocephalus
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.
20%

21. Blood transfusion in hypothermia
High dose IV methyleprednisone;
Taper gradually to prevent seizure relapse
It patient has electrolyte imbalance and hypothermia
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate

22. stroke with lower facial palsy - pronator drift despite on aspirin
RBC count >6000
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA

23. MG
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Spastic paraparesis
Acetylecholinersterase inhibitors
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48

24. Patient with carbamazepine; What should be advice?
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
82% specific for dementia
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

25. prodrome of vasovagal syncope
Entacapone - COMT inhibitor
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
90% of right handed and 60% of left handed persons; speech and language function
Tunnel vision - diaphoresis - nausea - pallor

26. What mmse score suggest dementia
Gilberts disease
<20; if patient scores >25 benign forgetfulness
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Get up from chair walk a short distance turn around and sit; screening test for fall

27. 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
Verapamil
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
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

28. walking like drunken sailor; jerky hesitant and walks in zigzag pattern
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Cerebellar lesion
Taper gradually to prevent seizure relapse
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin

29. How to differentiate medial and lateral pontine syndrome
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
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Despite the term neuroma they arise from schwann cells - schwanoma

30. How to diffrentiate tick borne paralysis from GBS and spinal cord tumor
Clonidine will take care both high bp and withdrawal
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal

31. differentiate wenicke and korsakoff
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
Corticosteroid and acyclovir
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate

32. dementia plus urinary incontinence
Normal pressure hydrocephalus
Cerebral palsy; dx mri
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Upright supine position

33. labyrinthitis
Follows viral illness; vertigo - tinnitus - nausea. self limiting
90% of right handed and 60% of left handed persons; speech and language function
Diabetes insipidus
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure

34. When to use brain spect scintigraphy to confirm brain death
It patient has electrolyte imbalance and hypothermia
Propranolol or primidone
82% specific for dementia
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

35. excessive elevation of legs during walking (toe touch floor earlier than heels)
MS
Distal lower motor neuron disease
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
RBC count >6000

36. How to differentiate medial and lateral medullary syndrome
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
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;
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica

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

38. differentiate lewy body dementia and vascular dementia
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
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
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

39. impaired perception of complex sounds
Corticosteroid and acyclovir
Aphasia - neglect - agnosia - acalculia etc
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.
Lesion in nondominant temporal lobe

40. When headache is presenting complaint of brain tumor
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Verapamil
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;

41. How to differentiate traumatic LP and SAH
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Taper gradually to prevent seizure relapse
Cholinesterase inhibitor; and antiparkinsonism drugs

42. How to differentiate parkinson and benign essential tremor
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
High dose IV methyleprednisone;
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
20%

43. 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;
Cholinesterase inhibitor; and antiparkinsonism drugs
Taper gradually to prevent seizure relapse
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner

44. drags leg forward in every steps - no knee flexion; hip flexion and straight legs
Spastic paraparesis
Taper gradually to prevent seizure relapse
Coronary artery disease
Follows viral illness; vertigo - tinnitus - nausea. self limiting

45. How to differentiate botulism from tick born paralysis - GBS and MG
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Botulism has descending paralysis in contrast othere have ascending paralysis
Obturator n lesion
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement

46. How to prevent prevent frequency of MS exacerbation
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
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

47. patient with hx of cluster headache p/w retroorbital pain lacrimation - vomiting suddenly
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Nystagmus on far lateral gaze
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Wernicke's encephalopathy; due to thiamine definition; medical emergency

48. Unable to copy of matchstick - unable to dress up
Construction apraxia; lesion in non dominant parietal lobe (right)
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Tunnel vision - diaphoresis - nausea - pallor
Acetylecholinersterase inhibitors

49. Tx of bells palsy
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
Nystagmus on far lateral gaze
Corticosteroid and acyclovir
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty

50. How to perform apnea test
Cerebral palsy; dx mri
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
MS
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.