USMLE questions

Question 1

Medication that slows progression of relapsing-remitting MS?

Answer 1

IFN-beta

Question 2

Underlying pathology of lacunar infarcts?

Answer 2

Combination of microatheroma and lipohyalinosis

Question 3

Are lacunar infarcts often embolic?

Answer 3

NO

Question 4

Most common site for lacunar infarct?

Answer 4

Posterior limb of the internal capsule, producing purely motor stroke (corticospinal, corticobulbar fibers)

Question 5

Organism most commonly causing spinal epidural abscess?

Answer 5

Staph aureus

Question 6

Typical features of cerebellar degeneration?

Answer 6

Progressive gait dysfunction, truncal ataxia, nystagmus, intention tremor or dysmetria, impaired rapid alternating movements (dysdiadochokinesia)

Question 7

Organisms most commonly responsible for brain abscess 2/2 sinus infection?

Answer 7

Aerobic and anaerobic streptococci (60-70%), Bacteroides (anearobes, 20-40%)

Question 8

Lambert-Eaton Syndrome: clinical presentation

Answer 8

often seen in SCLC, antibodies to pre-synaptic voltage-gated Ca++ channels, proximal muscle weakness and malaise; tx w/plasmapheresis and immunosuppressive therapy

Question 9

Trihexylphenidyl….what?

Answer 9

antimuscarinic anti-Parkinsonian agent, classic sx are “red as a beet, dry as a bone, hot as a hare, blind as a bat, mad as a hatter, full as a flask” + HA, confusion, dizziness, tachycardia

Question 10

Trihexylphenidyl can precipitate what?

Answer 10

Acute angle closure glaucoma

Question 11

Patients who are anti coagulated and present with severe intracranial bleeding should be given what?

Answer 11

Fresh frozen plasma (FFP), target INR <1.5

Question 12

Classical presentation of multi-system atrophy (Shy-Drager Syndrome)

Answer 12

1. Parkinsonism
2. Autonomic dysfunction (postural hypotension, abnormal swelling, bowel/bladder dysfunction, salivation or lacrimation, impotence, gastroparesis)
3. Widespread neurological signs (cerebellar, pyramidal, LMN)

Question 13

EEG pattern in CJD?

Answer 13

Periodic synchronous bi- or triphasic sharp wave complexes

Question 14

Metoclopramide - what is it, and what is a common side effect?

Answer 14

Dopamine receptor antagonist used to treat nausea, vomiting, and gastroparesis; can cause dystonia

Question 15

Steppage gait is due to…

Answer 15

L5 radiculopathy

Question 16

Primidone is?

Answer 16

anticonvulsant that converts into phenylethylmalonamide and phenobarbital, may precipitate AIP (abdominal pain, neurologic and psychiatric abnormalities)

Question 17

Intracranial HTN - symptoms

Answer 17

Diffuse headaches (worse in morning), n/v early in day, vision changes, papilledema, CN deficits, somnolence, confusion, unsteadiness, Cushing’s reflex (HTN and bradycardia) – requires CT/MRI

Question 18

Heat stroke: definition

Answer 18

Core temp >40 deg C (>104), AMS

Question 19

Treatment of restless leg syndrome?

Answer 19

Dopamine agonists (eg pramipexole)

Question 20

Myasthenia gravis - imaging study to check?

Answer 20

CT of chest to r/o thymoma

Question 21

Migraine headache - best initial treatment?

Answer 21

Anti-emetic (eg prochlorperazine)

Question 22

Initial treatment of heat stroke

Answer 22

Rehydration and evaporative cooling

Question 23

Patients in status epilepticus are at risk for developing what?

Answer 23

Cortical necrosis

Question 24

Definition of status epilepticus

Answer 24

Any single seizure lasting >5min or a cluster of seizures w/patient not recovering mental status in between

Question 25

most common site for ulnar nerve compression

Answer 25

elbow

Question 26

Neurologic sx of hypokalemia

Answer 26

flaccid paralysis, hyporeflexia, tetany, weakness, fatigue, muscle cramps

Question 27

Bilateral trigeminal neuralgia: dx correlate

Answer 27

MS

Question 28

Riluzole

Answer 28

glutamate inhibitor approved for use in pt with ALS