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 differentiate medial and lateral medullary syndrome
Vitamin B12 deficiency
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;
Coronary artery disease
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l

2. acoustic neuroma
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
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

3. walking like drunken sailor; jerky hesitant and walks in zigzag pattern
Cerebellar lesion
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Diabetes insipidus

4. How to confirm braindeath?
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
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Myasthenia; due to autoantibodies against acetylecholine receptor;
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.

5. How to differentiate traumatic LP and SAH
Cerebellar lesion
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Diabetes insipidus

6. How to tx acute exacerbation of MS
82% specific for dementia
High dose IV methyleprednisone;
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
Upright supine position

7. differentiate picks and huntington
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
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
Clonidine will take care both high bp and withdrawal

8. construction worker works in squatting position; now develop decreased sensation over anterolateral thigh
High dose IV methyleprednisone;
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Aspirin - control HTN and swallow eval before giving any oral meds
Cholinesterase inhibitor; and antiparkinsonism drugs

9. What bp med to be given in a patient with high bp and signs of opioid withdrawal
It patient has electrolyte imbalance and hypothermia
82% specific for 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
Clonidine will take care both high bp and withdrawal

10. excessive elevation of legs during walking (toe touch floor earlier than heels)
Difficulty in writing - calculating - distinguishing left and write
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Distal lower motor neuron disease
Verapamil

11. korsafoff psychosis
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Vitamin B12 deficiency
Normal pressure hydrocephalus

12. brain stem lesion
Despite the term neuroma they arise from schwann cells - schwanoma
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Deficit in cranial nerve function

13. earliest sign of phenytoin toxicity
Gilberts disease
Construction apraxia; lesion in non dominant parietal lobe (right)
Nystagmus on far lateral gaze
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA

14. at first tingling in toes and feet then weakness in extremities
Deficit in cranial nerve function
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Normal pressure hydrocephalus

15. lesion in dominant tempora lobe
Acetylecholinersterase inhibitors
Obturator n lesion
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
MS

16. How to differentiate medial and lateral pontine syndrome
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
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure
Cholinesterase inhibitor; and antiparkinsonism drugs
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

17. lesion in dominant parietal lobe
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Difficulty in writing - calculating - distinguishing left and write
Propranolol or primidone
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal

18. impaired perception of complex sounds
Distal lower motor neuron disease
Lesion in nondominant temporal lobe
Femoral n lesion
Upright supine position

19. Tx of GBS
Cerebellar lesion
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
RBC count >6000
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS

20. How to tx lewy body dementia
Cholinesterase inhibitor; and antiparkinsonism drugs
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Entacapone - COMT inhibitor
Corticosteroid and acyclovir

21. impaired hepatic conjugation of billirubin
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Verapamil
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Gilberts disease

22. double vision at the end of day and ptosis
Propranolol or primidone
Myasthenia; due to autoantibodies against acetylecholine receptor;
Tunnel vision - diaphoresis - nausea - pallor
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

23. medial thigh sensory loss and weakness in addcution
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
Obturator n lesion
Cholinesterase inhibitor; and antiparkinsonism drugs

24. What is can be used cluster headache prevention
Verapamil
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
Deficit in cranial nerve function
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy

25. Blood transfusion in hypothermia
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Botulism has descending paralysis in contrast othere have ascending paralysis
20%
Construction apraxia; lesion in non dominant parietal lobe (right)

26. cortical lesion
Aphasia - neglect - agnosia - acalculia etc
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Clonidine will take care both high bp and withdrawal

27. Why V12 deficient develop hypokalemia after tx with b12
Get up from chair walk a short distance turn around and sit; screening test for fall
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Entacapone - COMT inhibitor
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel

28. hx of epilepsy - now unresponsive - slight twhiching of mouth and arms
Taper gradually to prevent seizure relapse
Gilberts disease
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
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin

29. botulism
Diabetes insipidus
Clonidine will take care both high bp and withdrawal
Antitoxin
Pure motor lacunar stroke; aspirin failure; give more aggressive antiplatelet therapy with clopidogrel

30. Acute onset of left arm weakness
Difficulty in writing - calculating - distinguishing left and write
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
Upright supine position

31. When to start fibrinolytic therapy in stroke patient?
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Tunnel vision - diaphoresis - nausea - pallor
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l

32. How to diffrentiate tick borne paralysis from GBS and spinal cord tumor
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Deficit in cranial nerve function
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Botulism has descending paralysis in contrast othere have ascending paralysis

33. How to differentiate dementias
Deficit in cranial nerve function
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Corticosteroid and acyclovir
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge

34. How to stop antiepileptic drugs
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Taper gradually to prevent seizure relapse
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
EPV - campylobacter - HSV

35. differentiate lewy body dementia and vascular dementia
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
Tunnel vision - diaphoresis - nausea - pallor
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
Cholinesterase inhibitor; and antiparkinsonism drugs

36. severe headache and high BP
Myasthenia; due to autoantibodies against acetylecholine receptor;
82% specific for dementia
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
Do CT scan at first to r/o SAH - if ct neg lumbar puncture

37. When to use brain spect scintigraphy to confirm brain death
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
It patient has electrolyte imbalance and hypothermia
Verapamil
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

38. cluster headache
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
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
Corticosteroid and acyclovir

39. infections in GBS
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica
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;
EPV - campylobacter - HSV
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

40. How to tx stroke patient came after 6h
Construction apraxia; lesion in non dominant parietal lobe (right)
Vitamin B12 deficiency
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Aspirin - control HTN and swallow eval before giving any oral meds

41. 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

42. MMSE score of less than 24
82% specific for dementia
Corticosteroid and acyclovir
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l

43. GBS
IVIG and plasmapheresis
20%
EPV - campylobacter - HSV
Verapamil

44. Tx of bells palsy
EPV - campylobacter - HSV
Antitoxin
Corticosteroid and acyclovir
Spastic paraparesis

45. contraindication of sumatripta
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
20%
Distal lower motor neuron disease
Coronary artery disease

46. impaired vibration and increased DTR
Myasthenia; due to autoantibodies against acetylecholine receptor;
Vitamin B12 deficiency
Reduced efficacy of OCP
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

47. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Femoral n lesion
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Cerebral palsy; dx mri

48. labyrinthitis
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
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
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening

49. How to prevent prevent frequency of MS exacerbation
Corticosteroid and acyclovir
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.
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
Severe flaccid paralysis - patient on mech ventilation; bubar palsy; resp failure

50. women with unilateral eye pain; neurlogic symptoms here there at different times
Coronary artery disease
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge
Construction apraxia; lesion in non dominant parietal lobe (right)