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USMLE Step3 Neurology

Subjects : health-sciences, usmle-step-3

Instructions:

Answer 50 questions in 15 minutes.
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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. What percent of dementia is reversible
Diabetes insipidus
Despite the term neuroma they arise from schwann cells - schwanoma
20%
Obturator n lesion

2. labyrinthitis
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
Construction apraxia; lesion in non dominant parietal lobe (right)
Follows viral illness; vertigo - tinnitus - nausea. self limiting
Aspirin - control HTN and swallow eval before giving any oral meds

3. indication of plasmapheresis in GBS
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
Myasthenia; due to autoantibodies against acetylecholine receptor;
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID

4. Most effective to reduce aspiration in stroke or patient with swallowing dysfunction
High dose IV methyleprednisone;
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.
Upright supine position
Reduced efficacy of OCP

5. acoustic neuroma
Corticosteroid and acyclovir
<20; if patient scores >25 benign forgetfulness
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Despite the term neuroma they arise from schwann cells - schwanoma

6. 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;
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Autospy gold standard
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy

7. infections in GBS
EPV - campylobacter - HSV
Autospy gold standard
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Propranolol or primidone

8. How to perform apnea test
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Preoxygenate and then disconnect ventilator - absence of respiratory drive for 8-10 min with PCO2 >60 pH <7.28 suggest positive apnea test
Cerebral palsy; dx mri
Follows viral illness; vertigo - tinnitus - nausea. self limiting

9. When headache is presenting complaint of brain tumor
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Wernicke's encephalopathy; due to thiamine definition; medical emergency

10. anerior and anteriomedial thigh paresthesia - decreased DTR
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
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;
Wernicke's encephalopathy; due to thiamine definition; medical emergency
Femoral n lesion

11. Why V12 deficient develop hypokalemia after tx with b12
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
20%
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48

12. best diagnosis for parkinsonim
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
Autospy gold standard
Despite the term neuroma they arise from schwann cells - schwanoma
Coronary artery disease

13. How to differentiate traumatic LP and SAH
Lesion in nondominant temporal lobe
90% of right handed and 60% of left handed persons; speech and language function
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
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH

14. How to differentiate medial and lateral medullary syndrome
CT scan - if no bleeding tPA - then freq neurocheck - strict BP control with IV beta blocker; bp should be below 180/105;
Vitamin B12 deficiency
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;

15. double vision at the end of day and ptosis
Aspirin - control HTN and swallow eval before giving any oral meds
MS
Myasthenia; due to autoantibodies against acetylecholine receptor;
Cerebellar lesion

16. at first tingling in toes and feet then weakness in extremities
Autospy gold standard
Progressive paralysis in GBS; absent DTR - flaccid paralysis; then resp failure
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
Do CT scan at first to r/o SAH - if ct neg lumbar puncture

17. impaired vibration and increased DTR
Deficit in cranial nerve function
It patient has electrolyte imbalance and hypothermia
Vitamin B12 deficiency
Follows viral illness; vertigo - tinnitus - nausea. self limiting

18. what drug is used to extend effects of levodopa
Do CT scan at first to r/o SAH - if ct neg lumbar puncture
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.
Entacapone - COMT inhibitor
Acetylecholinersterase inhibitors

19. craniopharyngioma
Myasthenia; due to autoantibodies against acetylecholine receptor;
Obturator n lesion
Diabetes insipidus
82% specific for dementia

20. dominant parietal lobe on the left side
90% of right handed and 60% of left handed persons; speech and language function
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Femoral n lesion
RBC count >6000

21. benign essential tremor
Alzheimers have decreased level acetylecholine due to degeneration of choline acetyltransferase which synthesize acetylecholine; donepezil inhibits breakdown of aceytylecholine thus increases its level
Corticosteroid and acyclovir
Propranolol or primidone
Injury to lateral femoral cutaneous nerve; small sensory nerve direct branch of lumbar plexus; meralgia paresthetica

22. Should we tx htn in acute ischemic stroke

23. How to diffrentiate tick borne paralysis from GBS and spinal cord tumor
Deficit in cranial nerve function
Cerebellar lesion
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Difficulty in writing - calculating - distinguishing left and write

24. What is can be used cluster headache prevention
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Verapamil
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
MS

25. earliest sign of phenytoin toxicity
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate
Nystagmus on far lateral gaze
IVIG and plasmapheresis
Cerebral palsy; dx mri

26. When to start fibrinolytic therapy in stroke patient?
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.
Cerebellar lesion
First 3 to 4.5 hours following symptom onset; CT scan should be done first to r/o intracranial hemorrahge

27. How to differentiate parkinson and benign essential tremor
Taper gradually to prevent seizure relapse
Myasthenia; due to autoantibodies against acetylecholine receptor;
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
Corticosteroid and acyclovir

28. oligoclonal band in CSF
Autospy gold standard
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
MS
Not within 24 hours; give afte 24-48 hours if patient stable

29. When to suspect traumatic LP
Frontotemporal: weird behviors - NPH: incontinence - enlarged ventricls - gait prob; vascular: gradually progressive - mild dementia; Lewy body: l for hallucination +parkinsonism l
Construction apraxia; lesion in non dominant parietal lobe (right)
Acetylecholinersterase inhibitors
RBC count >6000

30. differentiate wenicke and korsakoff
RBC count >6000
Clonidine will take care both high bp and withdrawal
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
Develop hypocalcemia (muscle spasms - diaphoresis - bilateral hand contracture); cannot metabolize citrate to lactate

31. How to stop antiepileptic drugs
Distal lower motor neuron disease
Taper gradually to prevent seizure relapse
Coronary artery disease
Not within 24 hours; give afte 24-48 hours if patient stable

32. When to give aspirin when patient on tPA after stroke
Not within 24 hours; give afte 24-48 hours if patient stable
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
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
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

33. differentiate picks and huntington
RBC count >6000
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
Autospy gold standard
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

34. 2 yr old child with developmental delay; crawing at 11m; scissoring gait
82% specific for dementia
Cerebral palsy; dx mri
MS
Verapamil

35. Patient with carbamazepine; What should be advice?
Construction apraxia; lesion in non dominant parietal lobe (right)
20%
IVIG and plasmapheresis
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

36. How to tx lewy body dementia
Xanthochrmia and discoloration of centrifuged CSF due to Hb breakdown; present in 90% of SAH
Uptake K by newly formed mature RBC can lead to severe hypokalemia; serum k should be monitor Q48
Reduced efficacy of OCP
Cholinesterase inhibitor; and antiparkinsonism drugs

37. contraindication of sumatripta
Coronary artery disease
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
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS
MS

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

39. patient with hx of cluster headache p/w retroorbital pain lacrimation - vomiting suddenly
Get up from chair walk a short distance turn around and sit; screening test for fall
It patient has electrolyte imbalance and hypothermia
Acute attack; tx with 100% O2; other options are sumatriptan sq/intranasal; ergot - NSAID
Follows viral illness; vertigo - tinnitus - nausea. self limiting

40. 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
Younger patients <60yrs due to concerns about long term efficacy and s/e levodopa
Propranolol or primidone
Reduced efficacy of OCP

41. hx of epilepsy - now unresponsive - slight twhiching of mouth and arms
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
Status epilepticus-clue is twhiching; seizure lasting longer than 5-10 min; tx benzo after ABC - if fails - phenobarbital or phenytoin
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
MS: CSF increased IgG -IgM and IgA also increased. not specific to MS

42. walking like drunken sailor; jerky hesitant and walks in zigzag pattern
82% specific for dementia
EPV - campylobacter - HSV
Cerebellar lesion
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

43. korsafoff psychosis
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
If glucose is given instead of thiamin in korsakoff psychosis; patient confabulate to fill gaps in memory; mamilary bodies affected; DX mri-increased enhancement
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner

44. Acute onset of left arm weakness
MCA stroke; if comes in < 3-4.5 h - do CT and if neg give tPA
EPV - campylobacter - HSV
Get up from chair walk a short distance turn around and sit; screening test for fall
Aphasia - neglect - agnosia - acalculia etc

45. get up and go test
Tick born paralysis fastest manifestation. presents within a day of exposure; no FEVER - csf exam normal
Pineal tumor; parinaud syndrome; some releases hcg which cause precocious puberty
Spontaneous remission; admit if suspected and monitor pulse ox for resp failure
Get up from chair walk a short distance turn around and sit; screening test for fall

46. drags leg forward in every steps - no knee flexion; hip flexion and straight legs
Bilateral but worse unilateral - morning headache - n/v - headache worsened by bending - night awakening
Obturator n lesion
Spastic paraparesis
Vitamin B12 deficiency

47. What bp med to be given in a patient with high bp and signs of opioid withdrawal
Difficulty in understanding spoken or written language; difficulty in expressing thoughts in a meaningful manner
Distal lower motor neuron disease
Clonidine will take care both high bp and withdrawal
82% specific for dementia

48. 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
Beta interferon and glatiramer acetate; they are teratogenic; contraception should be advised
HTN upto 220/120 permitted in patient who did n't receive thrombolytic therapy
Construction apraxia; lesion in non dominant parietal lobe (right)

49. medial thigh sensory loss and weakness in addcution
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
Obturator n lesion
Deficit in cranial nerve function
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

50. Tx of bells palsy
Corticosteroid and acyclovir
82% specific for dementia
Aspirin - control HTN and swallow eval before giving any oral meds
MS