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Usmle Neurosciences Board Review
Usmle Neurosciences Board Review
Step I # 1
Neuroscience
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A. Genu
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A. tyrosine
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D. tyrosine hydroxylase
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C. curare
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C. nodes of Ranvier
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B. synapse
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B. unipolor or pseudounipolar
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D. b and c
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A. non-communicating hydrocephalus
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D. foramen of Monro
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A. cervical level
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A. facial
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C. 15%
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D. posterior cerebral.
Superior alternating hemiplegia, a.k.a.
Webers syndrome.
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B. Hyposexuality.
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A 31 year old female has noted recent difficulty with writing. She
has difficulty controlling her hand movements, and the writing is
nearly illegible. A neurological examination reveals decreased
strength in the right upper extremity and decreased sensation over
the left lower extremity. She has no decrease in mentation, and
there is no reported seizure activity. A lumbar puncture is
performed, and the CSF contains elevated levels of IgG, some
mononuclear cells, and oligoclonal bands on gel electrophoresis.
Which of the following pathologic findings in the CNS best accounts
for these findings:
A Loss of pigmented neurons in the substantia nigra
B Perivascular lymphocytes with demyelinated axons in white
matter
C Increased neurofibrillary tangles and neuritic plaques in the
cortex
D Periventricular lymphoid aggregates with cells marking with
CD19
E Foci of multnucleated cells and macrophages in grey and white
matter
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A 29 year old HIV positive man with previous and ongoing intravenous
drug use is initially referred to you for evaluation of pain and numbness in
the feet. Examination, at that time, revealed impaired sensation to pin,
temperature and touch to the mid calf level symmetrically and absent
ankle reflexes. The patient did not have Babinski signs and strength is
normal in all extremities. Nerve conduction studies demonstrate mild
decrease in nerve conduction velocities in the all four extremities.
Two months later you see the patient in the clinic because of a new
complaint of increasing neck pain for the past three days. Pain is now
radiating from the neck into the upper extremities and the patient is
complaining of weakness in the legs. The patient has a fever of 101.5
degrees and pain on motion of the neck in all directions. Your neurologic
examination shows depressed biceps and increased triceps reflexes.
Knee jerks (patellar reflexes) are increased and the patient now has
Babinski signs bilaterally. You also find mild weakness and spasticity in
both legs.
The patients second problem (neck pain with radiation to the arms) will
require evaluation
Which test should be obtained?
A. MRI of the cervical spine
B. Nerve biopsy
C. Repeat nerve conduction studies
D. Lumbar puncture (spinal tap) to determine CSF protein and cell counts
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A 29 year old HIV positive man with previous and ongoing intravenous
drug use is initially referred to you for evaluation of pain and numbness
in the feet. Examination, at that time, revealed impaired sensation to
pin, temperature and touch to the mid calf level symmetrically and
absent ankle reflexes. The patient did not have Babinski signs and
strength is normal in all extremities. Nerve conduction studies
demonstrate mild decrease in nerve conduction velocities in the all four
extremities.
Two months later you see the patient in the clinic because of a new
complaint of increasing neck pain for the past three days. Pain is now
radiating from the neck into the upper extremities and the patient is
complaining of weakness in the legs. The patient has a fever of 101.5
degrees and pain on motion of the neck in all directions. Your
neurologic examination shows depressed biceps and increased triceps
reflexes. Knee jerks (patellar reflexes) are increased and the patient
now has Babinski signs bilaterally. You also find mild weakness and
spasticity in both legs.
The most likely diagnosis is:
A. Chronic inflammatory demyelinating polyneuropathy
B. HIV myelopathy
C. Spinal epidural abscess
D. Ruptured cervical disk
E. Spinal meningioma
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C is CORRECT.
A glioblastoma multiforme is a large, fastgrowing neoplasm that can produce
unilateral brain swelling and papilledema.
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This lesion appeared on CT scan as a discreet mass beneath the dura and
was seen to compress the underlying cerebral hemisphere. The patient is a
45 year old female who presented with headaches for the past month. The
best diagnosis is:
A Meningioma
B Astrocytoma, low grade
C Ependymoma
D Metastasis
E Tuberculoma
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A is CORRECT.
A meningioma is a benign neoplasm that
is slow-growing and can compress the
underlying brain without invasion. The
parasagittal region is a common location.
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This 79 year old woman was driving her car when she had the sudden onset of a severe
headache. She pulled in to a service station and stopped the car. Then she slumped over
the wheel. She was taken to the emergency room, where she remained comatose and died
hours later. The most likely explanation for the gross appearance seen here is:
A Glioblastoma multiforme
B Thromboembolization with cerebral infarction
C Multiple sclerosis
D Ruptured berry aneurysm
E Huntington's disease
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D is CORRECT.
Rupture of a berry aneurysm involving the
circle of Willis and its branches is a
sudden event that produces hemorrhage
into the subarachnoid space at the base
of the brain.
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A 60 year old male has the lesion shown here at autopsy. He had suddenly lost consciousness,
and when he again became alert, he was unable to move his left arm or speak. Which of the
following underlying disease processes is he most likely to have to explain these findings:
A Hypertension with chronic renal failure
B Rheumatic heart disease with left atrial mural thrombosis
C Chronic alcoholism with micronodular cirrhosis
D Acquired immunodeficiency syndrome with low CD4 coun
E Papillary thyroid carcinoma with metastases to bone
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B is CORRECT.
Cerebral infarction can be the result of
thromboembolic disease. Many
thromboemboli originate in the left side of
the heart. Thromboembolic cerebral
infarctions can have hemorrhage, since
the embolus may not completely occlude
the artery.
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For the past year, a 34 year old woman has been treated with high
dose immunosuppressive therapy, including prednisone and
cytoxan, for high grade lupus nephritis. She now presents with
increasing headache and decreased mentation for about a week. A
complete blood count reveals that her WBC count is markedly
decreased. Based upon the microscopic appearance of the lesion
seen here with Gomori methenamine silver stain (next slide), the
most likely explanation for these findings is:
A Progressive multifocal leukoencephalopathy
B Multiple sclerosis
C Aspergillosis
D Herpes simplex encephalitis
E Cryptococcosis
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C is CORRECT.
The branching septate hyphae invading
the vascular wall are typical for infection
with Aspergillus.
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A 75 year old female has had progressively worsening mental function, as indicated by her son when
he brings his mother to see you. The son states that his mother is now frequently getting lost in the
neighborhood. He relates that she cannot easily feed or dress herself. She often does not seem to
know who he his. After a year-long course in a nursing home, she dies from a respiratory infection. The
brain at autopsy weighs 1025 gm and demonstrates frontal and parietal atrophy, with ex vacuo
ventricular dilation. The light microscopic appearance of the frontal cortex is seen here with
Bielschowsky silver stain. Which of the following statements best characterizes this process:
A A bloodborne pathogen led to this illness
B An amyloid angiopathy can be present
C Inheritance of this disease occurs in an autosomal dominant fashion
D A response to dopaminergic pharmacologic agents is often observed
E Aluminum toxicity can explain these findings
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B is CORRECT.
Amyloid can be present within the senile
plaques of Alzheimer's disease as well as
in peripheral cerebral arteries. Sometimes
the amyloid angiopathy leads to
intraparenchymal or subarachnoid
hemorrhage.
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(D) CORRECT.
The histologic finding is typical of
Alzheimer's disease. Persons with Down's
syndrome who live to middle age often
develop Alzheimer's disease.
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B. C8
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C. posterior funiculus
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C. the thalamus
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C. the tongue
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D. Substance P
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D. lateral rectus
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D. 3rd
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C. inferior oblique
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Good Luck!
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