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page 143

Neurology
Questions
ANATOMY AND PHYSIOLOGY
1.

Match the cell type with its characteristic. (p. 396)

_____ A. Astrocytes
_____ B. Microglia
_____ C. Oligodendroglia
_____ D. Schwann cells

2.

1.
2.
3.
4.

Destroyed in Gullain-Barr syndrome

Destroyed in multiple sclerosis
Form multinucleated giant cells
Maintain blood-brain barrier

Match the disease with its alteration in neurotransmitter. (p. 397)

_____ A. Alzheimers disease
_____ B. Anxiety
_____ C. Depression
_____ D. Schizophrenia

1.
2.
3.
4.

Decrease in acetylcholine
Decrease in dopamine
Increase in dopamine
Increase in norepinephrine

3.

Which substances cross the blood-brain barrier quickly? Which substances cross it slowly? (p. 398)
______________________________________________________________________________

4.

Match the area of the hypothalamus with its function. (p. 398)
_____ A. Anterior hypothalamus
_____ B. Lateral area
_____ C. Paraventricular nucleus
_____ D. Posterior hypothalamus
_____ E. Suprachiasmatic nucleus
_____ F. Supraoptic nucleus
_____ G. Ventromedial area

5.

1.
2.
3.
4.
5.
6.
7.

Circadian rhythm
Cooling
Heating
Hunger
Makes ADH
Makes oxytoxin
Satiety

What are the five functions of the limbic system? (p. 399) _________________________________
______________________________________________________________________________

6.

How does loss of dopamine in Parkinsons disease affect the excitatory pathway? How does it
affect the inhibitory pathway? (p. 400) _______________________________________________
______________________________________________________________________________
______________________________________________________________________________

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7.

In the image below, identify the components of the excitatory and inhibitory pathways. (p. 400)

8.

Which nucleus is affected in Parkinsons disease? In hemiballismus? In Huntingtons disease? (p.

401) __________________________________________________________________________

9.

What are the cardinal features of Parkinsons disease? (p. 401) ____________________________
______________________________________________________________________________

10.

Define the following terms. (p. 401)

A.

Athetosis __________________________________________________________________

B.

Chorea ___________________________________________________________________

C.

Dystonia __________________________________________________________________

D.

Myoclonus ________________________________________________________________
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11.

page 145

Match the area of a brain lesion with its clinical effect(s). (p. 403)
_____ A. Anterograde amnesia
_____ B. Contralateral hemiballismus
_____ C. Deficits in concentration, orientation and judgment
_____ D. Eyes look away from side of lesion
_____ E. Eyes look toward side of lesion
_____ F. Intention tremor and limb ataxia
_____ G. Klver-Bucy syndrome
_____ H. Reduced levels of arousal and wakefulness
_____ I. Spatial neglect syndrome
_____ J. Tremor at rest, chorea, or athetosis
_____ K. Truncal ataxia and dysarthria
_____ L. Wernicke-Korsakoff syndrome

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

Amygdala
Basal ganglia
Cerebellar hemisphere
Cerebellar vermis
Frontal eye fields
Frontal lobe
Hippocampus
Mamillary bodies
PPRF
Reticular activating system
Right parietal lobe
Subthalamic nucleus

12.

Fluent aphasia with impaired comprehension describes _______________ (Brocas/Wernickes)

aphasia, while nonfluent aphasia with intact comprehension describes _______________
(Brocas/Wernickes) aphasia. (p. 404)

13.

What is the major vascular territory covered by the ACA? MCA? PCA? (pp. 404-405) ___________
______________________________________________________________________________

14.

Label the Circle of Willis in the image below. (p. 405)

15.

On CT, an epidural hematoma _______________ (does/does not) cross suture lines, while a
subdural hematoma _______________ (does/does not) cross suture lines. (p. 406)

16.

A 50-year-old woman presents to the emergency department with a headache and numbness on
the right side. Her speech is difficult to understand, and her mouth droops when talking.
Noncontrast CT of the head shows bright areas. Should tPA be administered? (p. 407) _________

17.

What are the symptoms of normal pressure hydrocephalus? (p. 408) ________________________
______________________________________________________________________________

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18.

Which spinal nerves exit the intervertebral foramina above the corresponding vertebra? Which
spinal nerves exit the foramina below the corresponding vertebrae? (p. 408) __________________

19.

Where is a lumbar puncture usually performed? (p. 409) _________________________________

20.

In the chart below, compare and contrast the characteristics of upper vs. lower motor neuron
lesions. (p. 410)
Characteristic

UMN Lesion

LMN Lesion

Atrophy
Babinski reflex
Clasp knife spasticity
Fasciculation
Reflexes
Spastic paralysis
Tone
Weakness
21.

For each lesion in the image, identify the motor deficit and associated diseases. (pp. 411-412)

A. ____________________________________________________________________________
B. ____________________________________________________________________________
C. ____________________________________________________________________________
D. ____________________________________________________________________________
E. ____________________________________________________________________________
F. ____________________________________________________________________________
G. ____________________________________________________________________________
22.

Horners syndrome is associated with which three lesions? (p. 413) ________________________
______________________________________________________________________________
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23.

page 147

Fill in the chart below describing the cranial nerves. (pp. 416-416)

CN

Name

Function

Type (Sensory/
Motor/Both)

Location in
Brainstem

I
II
III
IV
V
VI

VII

VIII

IX

XI
XII

24.

Which CNs mediate the pupillary response? (p. 416) ____________________________________

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25.

If there is a lesion in CNs V and VII, which reflex is impaired? (p. 416) _______________________

26.

Which CNs mediate the gag reflex? (p. 416) ___________________________________________

27.

With a lesion in CN X, the uvula deviates _______________ (toward/away from) the side of the
lesion. (p. 418)

28.

With a lesion in CN XI, the head turns _______________ (toward/away from) the side of the lesion.
(p. 418)

29.

With a lesion in CN XII, the tongue deviates _______________ (toward/away from) the side of the
lesion. (p. 418)

30.

What is the obstruction in open/wide angle glaucoma? What is the obstruction in closed/narrow
angle glaucoma? Which one is painful? (p. 421) ________________________________________
______________________________________________________________________________

31.

Referring to the image below, which cranial nerve and muscle are tested with each movement?
(pp. 421-422)

Line A-B: _______________________________________________________________

Line C-D: _______________________________________________________________
Line E-F: _______________________________________________________________
32.

Identify the type of visual field defect in the image below. (p. 423)

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33.

page 149

Horizontal diplopia develops in a 26-year-old woman with multiple sclerosis. Examination reveals
she cannot adduct her left eye past midline and has a left-beating nystagmus in her right eye when
looking to the right. However, her left eye can adduct during convergence. Where is the lesion most
likely located? (pp. 424-425)? ______________________________________________________

PATHOLOGY
34.

Match the type of dementia with its defining characteristic. (p. 425)
_____ A. Alzheimers disease
_____ B. Creutzfeld-Jakob disease
_____ C. Frontotemporal dementia
_____ D. Lewy body dementia

35.

1.
2.
3.
4.

-Synuclein defect
Neurofibrillary tangles
Prions
Tau protein

For each case, identify the type of seizure and its first-line treatment. (pp. 426-431)
A.

A teenage boy suddenly stiffens, falls down, and experiences rhythmic jerking of his
extremities lasting 1 minute. ___________________________________________________

B.

A 7-year-old boy is referred to his primary physician for behavioral problems at school. He
spaces out during class. EEG shows a 3-Hz spike-and-wave pattern.
__________________________________________________________________________

36.

37.

C.

A 1-year-old girl is brought to the emergency department because she had been shaking and
unresponsive for 30 seconds. Her rectal temperature is 104F. ________________________

D.

A 45-year-old man who suffered a concussion from a car accident has episodes of jerky
movements of his left arm that he cannot control. He remembers the incident itself, but had
blacked out afterward. ________________________________________________________

For each case, identify the most likely neurocutaneous disorder. (p. 427)
A.

A 6-month-old presents with her first seizure. Woods lamp examination shows several areas
of hypopigmentation over her trunk and extremities. ________________________________

B.

A 6-month-old has a port wine stain over his left eye and cheek, extending to the tip of his
nose, with a sharp drop-off to normal-toned skin on the right side of his face. _____________

C.

A 6-month-old has congestive heart failure. Imaging shows a cavernous hemangioma in the
liver. ______________________________________________________________________

D.

A 6-month-old has multiple hyperpigmented brown macules scattered over the trunk and
upper extremities. ___________________________________________________________

For each case, identify the most likely brain tumor. (p. 428-429)
A.

A 49-year-old man presents with a 2-month history of morning headaches. CT of the head
shows a heterogenous-appearing mass with irregular borders crossing the corpus callosum.
__________________________________________________________________________

B.

A 40-year-old woman develops a small, well-circumscribed nodular-appearing lesion on her

right frontal lobe. It appears to be attached to the skull. ______________________________

C.

A 4-year-old boy presents with a 1-month history of morning headaches, abnormal gait, and
dysmetria. Imaging shows a pilocytic appearance in the posterior fossa. _________________

D.

A 7-year-old girl presents with bitemporal hemianopia. ______________________________

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38.

First Aid for the USMLE Step 1 2011 EXPRESS workbook

On MRI, _______________ (glioblastoma multiforme/meningioma/metastasis) has heterogenous

enhancement, _______________ (glioblastoma multiforme/meningioma/metastasis) has uniform
enhancement, and _______________ (glioblastoma multiforme/meningioma/metastasis) has ringenhancing lesions. (p. 429)

PHARMACOLOGY
39.

Match the drug with its indication for use. (pp 430-433)
_____ A. Acute status epilepticus
_____ B. Absence seizures
_____ C. Chronic pain
_____ D. Closed/narrow angle glaucoma
_____ E. Induction of anesthesia
_____ F. Insomina
_____ G. Opiate dependency
_____ H. Seizure prophylaxis in pregnancy

40.

1.
2.
3.
4.
5.
6.
7.
8.

Diazepam
Ethosuximide
Methadone
Phenobarbital
Pilocarpine
Thiopental
Tramadol
Zolpidem

Describe the mechanism of action for each drug commonly used to treat Parkinsons disease. (pp.
435-436)
A.

Benztropine ________________________________________________________________

B.

Bromocriptine ______________________________________________________________

C.

L-dopa/carbidopa ___________________________________________________________

D.

Selegiline __________________________________________________________________

Answers
ANATOMY AND PHYSIOLOGY
1.

A-4, B-3, C-2, D-1.

2.

A-1, B-4, C-2 D-3.

3.

Nonpolar/lipid-soluble substances cross rapidly (via diffusion); glucose and amino acids cross
slowly (by carrier-mediated transport).

4.

A-2, B-4, C-6, D-3, E-1, F-5, G-7.

5.

Feeding, Fleeing, Fighting, Feeling, and sex.

6.

Loss of dopamine inhibits the excitatory pathway and disinhibits (or excites) the inhibitory pathway.

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page 151

7.

8.

Substantia nigra; subthalamic nucleus; striatal nucleus.

9.

Tremor at rest, cogwheel Rigidity, Akinesia, and Postural instability.

10.

A.

Athetosis: Slow, writhing movements.

B.

Chorea: Sudden, jerky, purposeless movements.

C.

Dystonia: Sustained, involuntary muscle contractions.

D.

Myoclonus: Sudden, brief muscle contractions.

11.

A-7, B-12, C-6, D-9, E-5, F-3, G-1, H-10, I-11, J-2, K-4, L-8.

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12.

Wernickes; Brocas.

13.

The ACA supplies the medial surface of the brain, which covers the leg area of the motor and
sensory cortices. The MCA supplies the motor and sensory cortex of the face and arm. The PCA
supplies the occipital cortex.

14.

15.

Does not; does.

16.

This patient has had a stroke, and the bright areas on noncontrast CT indicate hemorrhage. Thus
tPA should not be administered.

17.

Ataxia, dementia, and urinary incontinence.

18.

Nerves C1-C7 exit above the corresponding vertebra; the others exit below the corresponding
vertebrae.

19.

In the L3-L4 or L4-L5 interspace.

20.
Characteristic

UMN Lesion

LMN Lesion

Atrophy

Babinski reflex

Clasp knife spasticity

Fasciculation

Reflexes

Spastic paralysis

Tone

Weakness

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21.

page 153

A.

Lower motor neuron lesions only, attributable to destruction of anterior horns; poliomyelitis
and Werdnig-Hoffmann disease.

B.

Random and asymmetric lesions due to demyelination; multiple sclerosis.

C.

Combination of upper and lower motor neuron deficits with no sensory deficit; amyotrophic
lateral sclerosis.

D.

Complete occlusion of anterior spinal artery with sparing of dorsal columns and tract of
Lissauer.

E.

Degeneration of dorsal roots and dorsal columns; tabes dorsalis.

F.

Damage to the anterior white commissure of the spinothalamic tract; syringomyelia.

G.

Demyelination of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts;

vitamin B12 neuropathy, vitamin E deficiency, and Friedrichs ataxia.

Pancoasts tumor, Brown-Squard syndrome, and late-stage syringomyelia.

22.
23.

CN

Name

Function

Type (Sensory/
Motor/Both)

Location in
Brainstem

Olfactory

Smell

Sensory

In cerebrum

II

Optic

Sight

Sensory

Midbrain

III

Oculomotor

Eye movements
Pupillary constriction
Eyelid opening

Motor

Midbrain

IV

Trochlear

Eye movements

Motor

Midbrain

Trigeminal

Facial sensation
Muscles of mastication

Both

Pons

VI

Abducens

Eye movements

Motor

Pons

VII

Facial

Muscles of facial
expression
Taste from anterior two
thirds of tongue
Lacrimation
Salivation
Eyelid closing
Stapedius muscle in ear

Both

Pons

VIII

Vestibulocochlear

Hearing
Balance

Sensory

Pons

Glossopharyngeal

Taste from posterior third

of tongue
Swallowing
Salivation
Chemo- and
baroreceptors of the
carotid body and sinus

Both

Medulla

IX

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Vagus

Taste from epiglottic

region
Swallowing
Palate elevation
Midline uvula
Muscles of pharynx and
larynx
Thoracoabdominal
viscera
Aortic arch chemo- and
baroreceptors

XI

Accessory

Head turning
Shoulder shrugging

Motor

Medulla

XII

Hypoglossal

Tongue movement

Motor

Medulla

Both

Medulla

24.

CNs II and III mediate the papillary response.

25.

The corneal reflex is impaired if there is a lesion in CNs V and VII.

26.

CNs IX and X mediate the gag reflex.

27.

The uvula deviates away from the side of the CN X lesion.

28.

There is weakness turning the head away from the CN XI lesion.

29.

The tongue deviates toward the side of the CN XII lesion.

30.

Open/wide angle glaucoma is due to obstructed outflow. Closed/narrow angle glaucoma is due to
obstructed flow between iris and lens. Closed/narrow angle glaucoma is painful.

31.

Line A-B (SR-SO): assesses CN III all but the superior oblique and the lateral rectus.
Line C-D (IO-IR): assesses CN IV the superior oblique.
Line E-F (MR-LR): assesses CN VI the lateral rectus.

32.

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33.

page 155

The reason her left eye can adduct during convergence but not during right lateral gaze is because
the oculomotor nerve itself works perfectly, but the connection between the abducens nuclei and
the oculomotor nuclei is impeded. The message to look right does not reach the left medial
rectus, causing the right eye to beat leftward because of the dysconjugate image. (If you are still
confused, now would be an excellent time to review INO.)

PATHOLOGY
34.

A-2, B-3, C-4, D-1.

35.

A.

Generalized tonic-clonic (grand mal) seizures. Treat with phenytoin, carbamazepine, or

valproic acid.

B.

Absence seizures. Treat with ethosuximide.

C.

Febrile seizures. Do not use anti-epileptics. Give acetaminophen for the fever. If it appears to
be a simple febrile seizure (1 seizure/illness; no previous febrile seizures), recurrence of
seizure is not likely.

D.

Simple partial seizures with secondary generalization. Virtually any anti-epileptic drug can be
used; the most common are phenytoin, carbamazepine, levetiracetam, and valproic acid.

A.

Tuberous sclerosis.

B.

Sturge-Weber syndrome.

C.

Cavernous hemangiomas can occur in isolation, but are associated with von Hippel-Lindau
disease.

D.

Neurofibromatosis type 1.

A.

Glioblastoma multiforme.

B.

Meningioma.

C.

Medulloblastoma.

D.

Craniopharyngioma.

36.

37.

38.

Glioblastoma multiforme; meningioma; metastasis.

PHARMACOLOGY
39.

A-1, B-2, C-7, D-5, E-6, F-8, G-3, H-4.

40.

A.

Inhibits acetylcholine, which preferentially excites the inhibitory pathway over the excitatory
pathway. The net effect of acetylcholine is inhibition of the thalamus.

B.

Dopamine receptor agonist.

C.

Inhibits peripheral breakdown of L-dopa, which crosses the blood-brain barrier and is
converted to dopamine in the brain. The net effect is an increase of dopamine in the brain
milieu.

D.

Inhibits MAO-B enzyme, resulting in less breakdown of dopamine in the CNS.

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Notes
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