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Test your basic knowledge |
USMLE Step3 Neurology
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Study First
Subjects
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health-sciences
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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. walking like drunken sailor; jerky hesitant and walks in zigzag pattern
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
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
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
Cerebellar lesion
2. cortical lesion
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Gilberts disease
RBC count >6000
Aphasia - neglect - agnosia - acalculia etc
3. women with unilateral eye pain; neurlogic symptoms here there at different times
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
IVIG and plasmapheresis
Upright supine position
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
4. get up and go test
Vitamin B12 deficiency
Get up from chair walk a short distance turn around and sit; screening test for fall
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
Lesion in nondominant temporal lobe
5. What percent of dementia is reversible
20%
Normal pressure hydrocephalus
Diabetes insipidus
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
6. What mmse score suggest dementia
Spastic paraparesis
82% specific for dementia
Not within 24 hours; give afte 24-48 hours if patient stable
<20; if patient scores >25 benign forgetfulness
7. What is pronator drift
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
Despite the term neuroma they arise from schwann cells - schwanoma
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;
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
8. When to give aspirin when patient on tPA after stroke
<20; if patient scores >25 benign forgetfulness
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Nystagmus on far lateral gaze
Not within 24 hours; give afte 24-48 hours if patient stable
9. How to differentiate medial and lateral pontine syndrome
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
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
Corticosteroid and acyclovir
90% of right handed and 60% of left handed persons; speech and language function
10. Blood transfusion in hypothermia
Diabetes insipidus
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
<20; if patient scores >25 benign forgetfulness
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
11. labyrinthitis
Diabetes insipidus
Normal pressure hydrocephalus
Follows viral illness; vertigo - tinnitus - nausea. self limiting
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
12. korsafoff psychosis
Follows viral illness; vertigo - tinnitus - nausea. self limiting
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
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Lesion in nondominant temporal lobe
13. headache - non reactive pupil - fall on both sides during walking - impaired upward gaze
Aphasia - neglect - agnosia - acalculia etc
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
14. GBS
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
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
15. cluster headache
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
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.
RBC count >6000
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
16. oligoclonal band in CSF
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
MS
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.
17. construction worker works in squatting position; now develop decreased sensation over anterolateral thigh
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Cholinesterase inhibitor; and antiparkinsonism drugs
18. Tx of bells palsy
Femoral n lesion
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Corticosteroid and acyclovir
19. When to suspect traumatic LP
IVIG and plasmapheresis
RBC count >6000
Aspirin - control HTN and swallow eval before giving any oral meds
It patient has electrolyte imbalance and hypothermia
20. impaired vibration and increased DTR
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Myasthenia; due to autoantibodies against acetylecholine receptor;
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;
Vitamin B12 deficiency
21. How to manage stroke patient came within 4 hours
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
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;
22. differentiate wenicke and korsakoff
Acetylecholinersterase inhibitors
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
Difficulty in writing - calculating - distinguishing left and write
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
23. Acute onset of left arm weakness
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
Tunnel vision - diaphoresis - nausea - pallor
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Vitamin B12 deficiency
24. differentiate picks and huntington
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
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
Aspirin - control HTN and swallow eval before giving any oral meds
25. Unable to copy of matchstick - unable to dress up
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Antitoxin
Construction apraxia; lesion in non dominant parietal lobe (right)
IVIG and plasmapheresis
26. Tx of GBS
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; if patient scores >25 benign forgetfulness
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
27. How to differentiate traumatic LP and SAH
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Myasthenia; due to autoantibodies against acetylecholine receptor;
Vitamin B12 deficiency
High dose IV methyleprednisone;
28. Patient with carbamazepine; What should be advice?
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
Get up from chair walk a short distance turn around and sit; screening test for fall
IVIG and plasmapheresis
Vitamin B12 deficiency
29. alcoholic p/w confusion - ataxia - tremor - nystamgus
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30. at first tingling in toes and feet then weakness in extremities
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
Verapamil
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
31. acoustic neuroma
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Despite the term neuroma they arise from schwann cells - schwanoma
Lesion in nondominant temporal lobe
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. indication of plasmapheresis in GBS
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
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
82% specific for dementia
Follows viral illness; vertigo - tinnitus - nausea. self limiting
33. MG
Botulism has descending paralysis in contrast othere have ascending paralysis
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Acetylecholinersterase inhibitors
Diabetes insipidus
34. How to differentiate medial and lateral medullary syndrome
Distal lower motor neuron disease
Acetylecholinersterase inhibitors
Gilberts disease
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;
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
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Nystagmus on far lateral gaze
Reduced efficacy of OCP
36. drags leg forward in every steps - no knee flexion; hip flexion and straight legs
Spastic paraparesis
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Normal pressure hydrocephalus
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
37. What bp med to be given in a patient with high bp and signs of opioid withdrawal
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Clonidine will take care both high bp and withdrawal
Construction apraxia; lesion in non dominant parietal lobe (right)
Lesion in nondominant temporal lobe
38. 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
EPV - campylobacter - HSV
Entacapone - COMT inhibitor
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
39. impaired perception of complex sounds
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
MS
Lesion in nondominant temporal lobe
RBC count >6000
40. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Nystagmus on far lateral gaze
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
41. anerior and anteriomedial thigh paresthesia - decreased DTR
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
Difficulty in writing - calculating - distinguishing left and write
Normal pressure hydrocephalus
Femoral n lesion
42. When to start fibrinolytic therapy in stroke patient?
Despite the term neuroma they arise from schwann cells - schwanoma
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Botulism has descending paralysis in contrast othere have ascending paralysis
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
43. dementia plus urinary incontinence
Cerebellar lesion
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Normal pressure hydrocephalus
Distal lower motor neuron disease
44. differentiate lewy body dementia and vascular dementia
Antitoxin
Difficulty in writing - calculating - distinguishing left and write
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
Vitamin B12 deficiency
45. benign essential tremor
Verapamil
Propranolol or primidone
Clonidine will take care both high bp and withdrawal
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
46. infections in GBS
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Clonidine will take care both high bp and withdrawal
EPV - campylobacter - HSV
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
47. When to use dopamine agonist pramipexol in parkinson
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
Obturator n lesion
Aphasia - neglect - agnosia - acalculia etc
48. What is can be used cluster headache prevention
Verapamil
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
It patient has electrolyte imbalance and hypothermia
49. phenytoin and OCP
Entacapone - COMT inhibitor
Cerebellar lesion
Reduced efficacy of OCP
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
50. patient with hx of cluster headache p/w retroorbital pain lacrimation - vomiting suddenly
Reduced efficacy of OCP
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
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
Diabetes insipidus