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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. When to use brain spect scintigraphy to confirm brain death
Entacapone - COMT inhibitor
Despite the term neuroma they arise from schwann cells - schwanoma
It patient has electrolyte imbalance and hypothermia
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH

2. prodrome of vasovagal syncope
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;
Tunnel vision - diaphoresis - nausea - pallor
Verapamil
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.

3. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Deficit in cranial nerve function
RBC count >6000
Cerebral palsy; dx mri

4. What percent of dementia is reversible
20%
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Distal lower motor neuron disease
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner

5. Unable to copy of matchstick - unable to dress up
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Construction apraxia; lesion in non dominant parietal lobe (right)
Nystagmus on far lateral gaze
Verapamil

6. How to differentiate medial and lateral medullary syndrome
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
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;
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised

7. what drug is used to extend effects of levodopa
EPV - campylobacter - HSV
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Entacapone - COMT inhibitor
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. impaired vibration and increased DTR
Botulism has descending paralysis in contrast othere have ascending paralysis
Vitamin B12 deficiency
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal

9. brain stem lesion
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
Deficit in cranial nerve function
Lesion in nondominant temporal lobe
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

10. contraindication of sumatripta
20%
Autospy gold standard
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

11. botulism
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
Myasthenia; due to autoantibodies against acetylecholine receptor;
Antitoxin
Upright supine position

12. GBS
IVIG and plasmapheresis
Verapamil
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

13. How to diffrentiate tick borne paralysis from GBS and spinal cord tumor
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Aphasia - neglect - agnosia - acalculia etc
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal

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
Nystagmus on far lateral gaze
Spastic paraparesis
Femoral n lesion

15. drags leg forward in every steps - no knee flexion; hip flexion and straight legs
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Spastic paraparesis
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
MS

16. 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
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
Obturator n lesion
20%

17. How to differentiate traumatic LP and SAH
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
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
High dose IV methyleprednisone;
It patient has electrolyte imbalance and hypothermia

18. MG
Antitoxin
Acetylecholinersterase inhibitors
Normal pressure hydrocephalus
Difficulty in writing - calculating - distinguishing left and write

19. How to stop antiepileptic drugs
Autospy gold standard
EPV - campylobacter - HSV
Taper gradually to prevent seizure relapse
Difficulty in writing - calculating - distinguishing left and write

20. cortical lesion
Aphasia - neglect - agnosia - acalculia etc
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
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Do CT scan at first to r/o SAH - if ct neg lumbar puncture

21. women with unilateral eye pain; neurlogic symptoms here there at different times
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
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
Antitoxin

22. Most effective to reduce aspiration in stroke or patient with swallowing dysfunction
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Upright supine position
High dose IV methyleprednisone;
Obturator n lesion

23. at first tingling in toes and feet then weakness in extremities
Diabetes insipidus
Coronary artery disease
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised

24. impaired hepatic conjugation of billirubin
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Gilberts disease
It patient has electrolyte imbalance and hypothermia
Myasthenia; due to autoantibodies against acetylecholine receptor;

25. differentiate wenicke and korsakoff
Vitamin B12 deficiency
Tunnel vision - diaphoresis - nausea - pallor
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
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

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

27. What is can be used cluster headache prevention
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
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.
Verapamil

28. How to tx lewy body dementia
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Cholinesterase inhibitor; and antiparkinsonism drugs
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Construction apraxia; lesion in non dominant parietal lobe (right)

29. When to suspect traumatic LP
Propranolol or primidone
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;
RBC count >6000
IVIG and plasmapheresis

30. dominant parietal lobe on the left side
Aspirin - control HTN and swallow eval before giving any oral meds
MS
90% of right handed and 60% of left handed persons; speech and language function
Clonidine will take care both high bp and withdrawal

31. double vision at the end of day and ptosis
90% of right handed and 60% of left handed persons; speech and language function
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.
Myasthenia; due to autoantibodies against acetylecholine receptor;
Acetylecholinersterase inhibitors

32. severe headache and high BP
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Reduced efficacy of OCP
Tunnel vision - diaphoresis - nausea - pallor

33. headache - non reactive pupil - fall on both sides during walking - impaired upward gaze
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Not within 24 hours; give afte 24-48 hours if patient stable
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA

34. How to confirm braindeath?
82% specific for dementia
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.
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

35. How to manage stroke patient came within 4 hours
EPV - campylobacter - HSV
Clonidine will take care both high bp and withdrawal
Acetylecholinersterase inhibitors
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;

36. How to differentiate botulism from tick born paralysis - GBS and MG
Botulism has descending paralysis in contrast othere have ascending paralysis
Difficulty in writing - calculating - distinguishing left and write
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Antitoxin

37. What mmse score suggest dementia
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
82% specific for dementia
Distal lower motor neuron disease
<20; if patient scores >25 benign forgetfulness

38. 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
Distal lower motor neuron disease
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Propranolol or primidone

39. medial thigh sensory loss and weakness in addcution
Antitoxin
Lesion in nondominant temporal lobe
Obturator n lesion
Normal pressure hydrocephalus

40. labyrinthitis
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Antitoxin
Normal pressure hydrocephalus
Despite the term neuroma they arise from schwann cells - schwanoma

41. Acute onset of left arm weakness
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
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
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID

42. differentiate lewy body dementia and vascular dementia
Construction apraxia; lesion in non dominant parietal lobe (right)
90% of right handed and 60% of left handed persons; speech and language function
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
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. lesion in dominant tempora lobe
82% specific for dementia
Vitamin B12 deficiency
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner

44. 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
Autospy gold standard
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID

45. korsafoff psychosis
Entacapone - COMT inhibitor
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Upright supine position
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. benign essential tremor
Propranolol or primidone
IVIG and plasmapheresis
Botulism has descending paralysis in contrast othere have ascending paralysis
Obturator n lesion

47. When headache is presenting complaint of brain tumor
Gilberts disease
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure

48. When to use dopamine agonist pramipexol in parkinson
Taper gradually to prevent seizure relapse
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Obturator n lesion
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa

49. how donepezil - acetylecholinsterase inhibitor works in Alzheimers
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
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
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Gilberts disease

50. 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
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
MS
Vitamin B12 deficiency