USMLEasy 3

Question 0

Patient presents with centrocecal scotoma. Similar problems in family. Suspect diagnosis?

If nonfamilial – other causes?

Answer 0

Leber optic atrophy

Tobacco-alcohol amblyopia, syphilis, vitamin deficiencies

Question 1

Ocular bobbing? In child, Suggests?

Answer 1

Rapid downward deviation of both eyes followed by slow upward Eye movements

Pontine glioma

Question 2

Vestibular neuronitis?

Answer 2

Symptoms of vertigo and nystagmus without any other complaints

Question 3

Ménière’s disease?

Answer 3

Labyrinth dysfunction – vertigo, tinnitus, decreased hearing

No vomiting typical

Question 4

Atalgic gait?

Answer 4

Limp due to pain

Question 5

Causalgia caused by? Characterized by?

Answer 5

Trauma to nerves in the extremities

#Hypesthesia – decrease in perception of stimulus
#Dysesthesia – persistent pain
#allodynia – perception of pain with application of nonpainful stimuli

Question 6

Drugs that can trigger an acute intermittent porphyria?

Answer 6

Barbiturates, sulfa drugs, phenytoin, estrogen

Question 7

Papillitis? How to tell between papillitis and papilledema? Papillitis can be an early sign of?

Answer 7

Inflammation of the optic nerve head

Visual loss with papillitis (but not papilledema)

MS

Question 8

After eating fish, patient later develops fatigue, paresthesias and the sensation that a cold tuning fork feels excessively hot – suspected diagnosis? Pathophysiology? Treatment?

Answer 8

Ciguatoxin – Acts on sodium channels (increasing excitability)

Mannitol has some benefits

Question 9

Often the only objective sign of S-1 radiculopathy?

Answer 9

Hyporeflexia at the Achilles tendon

Question 10

Path of sensory neurons?

Answer 10

#dorsal columns to the medulla
#decussate in the Medulla as internal arcuate fibers and ascend into medial meniscus to VPL
#to cortex

Question 11

Oculomotor nerve most susceptible to trauma?

Answer 11

CN4

Question 12

With severe lead poisoning, very young children may die from?

Answer 12

Herniation secondary to massive brain edema

Question 13

Size of brain in down syndrome?

Answer 13

Smaller

Question 14

Noncompressive sciatica is usually caused by?

Answer 14

Lyme

Question 15

Signs of Nitrous oxide poisoning

Answer 15

electrical pain down the back flexion of the neck

Question 16

Canavan disease – age? Symptoms? Molecular cause? Effect on brain?

Answer 16

Six months; developmental regression, rigidity, myoclonic seizures

Defect in N-acetylaspartic acid

Macrocephaly

Question 17

Patient with railroad track pattern of calcifications?

Answer 17

Sturge-Weber

Question 18

Ménière’s disease – hearing loss is primarily over which frequencies?

Answer 18

Low frequencies

Question 19

Drug for spasmodic torticollis?

Answer 19

Trihexyphenidyl

Question 20

Typical location for a brain abscess?

Answer 20

Grey-white junction

Question 21

Foci of hemosiderin in cortex – likely cause?

Answer 21

Amyloid

Question 22

Signs of phenytoin toxicity? Normal levels?

Answer 22

Impaired attention, unsteady gait, nystagmus

10-20

Question 23

Most appropriate treatment for young patients with Parkinson’s With resting tremor as primary symptom?

Answer 23

Trihexyphenidyl

Question 24

Treatment for pseudotumor cerebri? Mechanism?

Answer 24

Acetazolamide - inhibits choroid plexus carbonic anhydrase (decreasing CSF production)

Question 25

Intraocular pressure elevation is the hallmark sign of? Associated signs?

Answer 25

Glaucoma; unilateral vision changes, red eye, headache

Question 26

Side effects of levodopa?

Answer 26

#Nausea/vomiting
#Anxiety/agitation

Question 27

Side effects of selegiline?

Answer 27

Serotonin syndrome (agitation, tachycardia, muscle rigidity, seizures)

Question 28

Young patient with painless vision loss with movement – no vascular risk factors – suspected diagnosis?

Visual field testing should show?

Answer 28

Papilledema (abrupt movements can cause vision loss)

Large blind spots

Question 29

Optic nerve pallor associated with?

Answer 29

#Resolving infarction
#MS or optic neuritis