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. severe headache and high BP
20%
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
EPV - campylobacter - HSV

2. brain stem lesion
Deficit in cranial nerve function
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Aspirin - control HTN and swallow eval before giving any oral meds
Diabetes insipidus

3. Patient with carbamazepine; What should be advice?
EPV - campylobacter - HSV
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
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
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

4. botulism
Antitoxin
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Reduced efficacy of OCP
Follows viral illness; vertigo - tinnitus - nausea. self limiting

5. 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;
Verapamil
Cerebral palsy; dx mri
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level

6. How to tx acute exacerbation of MS
High dose IV methyleprednisone;
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Tunnel vision - diaphoresis - nausea - pallor
Cholinesterase inhibitor; and antiparkinsonism drugs

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

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

8. prodrome of vasovagal syncope
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
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
Tunnel vision - diaphoresis - nausea - pallor
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner

9. 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
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
90% of right handed and 60% of left handed persons; speech and language function
RBC count >6000

10. differentiate wenicke and korsakoff
Taper gradually to prevent seizure relapse
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
Cerebral palsy; dx mri
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l

11. stroke with lower facial palsy - pronator drift despite on aspirin
Lesion in nondominant temporal lobe
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
MS

12. Should we tx htn in acute ischemic stroke

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

13. How to differentiate medial and lateral pontine syndrome
Obturator n lesion
Difficulty in writing - calculating - distinguishing left and write
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
It patient has electrolyte imbalance and hypothermia

14. 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
Acetylecholinersterase inhibitors
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
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

15. excessive elevation of legs during walking (toe touch floor earlier than heels)
Difficulty in writing - calculating - distinguishing left and write
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Distal lower motor neuron disease

16. lesion in dominant tempora lobe
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
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
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

17. What mmse score suggest dementia
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Nystagmus on far lateral gaze
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; if patient scores >25 benign forgetfulness

18. acoustic neuroma
Gilberts disease
Deficit in cranial nerve function
Not within 24 hours; give afte 24-48 hours if patient stable
Despite the term neuroma they arise from schwann cells - schwanoma

19. at first tingling in toes and feet then weakness in extremities
Difficulty in writing - calculating - distinguishing left and write
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Upright supine position

20. How to diffrentiate tick borne paralysis from GBS and spinal cord tumor
82% specific for dementia
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Not within 24 hours; give afte 24-48 hours if patient stable

21. best diagnosis for parkinsonim
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Autospy gold standard
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
Cholinesterase inhibitor; and antiparkinsonism drugs

22. What is can be used cluster headache prevention
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Tunnel vision - diaphoresis - nausea - pallor
Verapamil

23. drags leg forward in every steps - no knee flexion; hip flexion and straight legs
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Spastic paraparesis
Lesion in nondominant temporal lobe
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy

24. How to perform apnea test
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
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal

25. dominant parietal lobe on the left side
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
Entacapone - COMT inhibitor
90% of right handed and 60% of left handed persons; speech and language function
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin

26. headache - non reactive pupil - fall on both sides during walking - impaired upward gaze
Cholinesterase inhibitor; and antiparkinsonism drugs
Construction apraxia; lesion in non dominant parietal lobe (right)
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
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty

27. differentiate lewy body dementia and vascular dementia
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
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
Propranolol or primidone
Corticosteroid and acyclovir

28. korsafoff psychosis
Get up from chair walk a short distance turn around and sit; screening test for fall
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
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

29. indication of plasmapheresis in GBS
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure

30. impaired hepatic conjugation of billirubin
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
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
Gilberts disease
Aspirin - control HTN and swallow eval before giving any oral meds

31. what drug is used to extend effects of levodopa
Entacapone - COMT inhibitor
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
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;

32. dementia plus urinary incontinence
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Normal pressure hydrocephalus

33. How to tx stroke patient came after 6h
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Aspirin - control HTN and swallow eval before giving any oral meds
Normal pressure hydrocephalus
Verapamil

34. labyrinthitis
Gilberts disease
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Wernicke's encephalopathy; due to thiamine definition; medical emergency

35. phenytoin and OCP
Reduced efficacy of OCP
Autospy gold standard
Vitamin B12 deficiency
Not within 24 hours; give afte 24-48 hours if patient stable

36. oligoclonal band in CSF
Obturator n lesion
MS
Despite the term neuroma they arise from schwann cells - schwanoma
Tunnel vision - diaphoresis - nausea - pallor

37. How to tx lewy body dementia
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Cholinesterase inhibitor; and antiparkinsonism drugs
EPV - campylobacter - HSV
Aspirin - control HTN and swallow eval before giving any oral meds

38. cortical lesion
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Aphasia - neglect - agnosia - acalculia etc

39. get up and go test
Femoral n lesion
Get up from chair walk a short distance turn around and sit; screening test for fall
Despite the term neuroma they arise from schwann cells - schwanoma
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test

40. How to differentiate traumatic LP and SAH
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
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Antitoxin

41. How to prevent prevent frequency of MS exacerbation
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
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Aphasia - neglect - agnosia - acalculia etc
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised

42. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
Cerebral palsy; dx mri
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
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge

43. 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
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
Clonidine will take care both high bp and withdrawal
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;

44. Unable to copy of matchstick - unable to dress up
Diabetes insipidus
Propranolol or primidone
Construction apraxia; lesion in non dominant parietal lobe (right)
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level

45. contraindication of sumatripta
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Coronary artery disease
Taper gradually to prevent seizure relapse
Nystagmus on far lateral gaze

46. medial thigh sensory loss and weakness in addcution
Spastic paraparesis
20%
Obturator n lesion
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test

47. walking like drunken sailor; jerky hesitant and walks in zigzag pattern
Cerebellar lesion
IVIG and plasmapheresis
Cholinesterase inhibitor; and antiparkinsonism drugs
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner

48. How to differentiate dementias
IVIG and plasmapheresis
Gilberts disease
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l

49. benign essential tremor
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Clonidine will take care both high bp and withdrawal
EPV - campylobacter - HSV
Propranolol or primidone

50. Acute onset of left arm weakness
<20; if patient scores >25 benign forgetfulness
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
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
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate