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USMLE STEP 1 Neurology Exam Questions With Correct Answers

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USMLE STEP 1 Neurology Exam Questions With Correct Answers The notochord induces what to differentiate into what? - answerInduces overlying ECTODERM to differentiate into NEUROECTODERM and form NUERAL PLATE Neural plate then gives rise to? - answerNeural tube and neural crest cells Notochord b...

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©THEBRIGHT EXAM STUDY SOLUTIONS 8/19/2024 2:07 PM

USMLE STEP 1 Neurology Exam Questions
With Correct Answers

The notochord induces what to differentiate into what? - answer✔✔Induces overlying
ECTODERM to differentiate into NEUROECTODERM and form NUERAL PLATE

Neural plate then gives rise to? - answer✔✔Neural tube and neural crest cells

Notochord becomes what? - answer✔✔Nucleus pulposus of the intervertebral disks in adults

Alar Plate - answer✔✔Dorsal [Sensory]
Same orientation as spinal cord

Basal Plate - answer✔✔Ventral [Motor]
Same orientation as the spinal cord

How does FGF affect chordin and noggin? - answer✔✔FGF regulates chordin and noggin to
down regulate BMP which leads to neural plate induction

Three Primary Vesicles - answer✔✔1. Forebrain [Prosencephalon]
2. Midbrain [Mesencephalon]
3. Hindbrain [Rhombencphaln]

The Forebrain gives rise to: - answer✔✔1. Telencephalon [Cerebral hemispheres, lateral
ventricles]
2. Diencephalon [Thalamus, Third Ventricle]

The Midbrain gives rise to: - answer✔✔1. Mesencephalon [Midbrain, aqueduct]

The Hindbrain gives rise to: - answer✔✔1. Metencephalon [Pons, cerebellum, upper part of the
fourth ventricle]
2. Myelencephalon [Medulla, Lower part of the fourth ventricle]

,©THEBRIGHT EXAM STUDY SOLUTIONS 8/19/2024 2:07 PM
CNS/PNS Origins - answer✔✔Neuroectoderm = CNS neurons, ependymal cell [Inner lining of
ventricles, makes CSF], oligodendrocytes, astrocytes
Neural crest cells = PNS, schwann cells
Mesoderm = Microglia [Like Macrophages, originate from Mesoderm]

Neural tube defects - answer✔✔NEUROPORES fail to fuse [4th week] → Persistent connection
between amniotic cavity and spinal canal
Associated with:
1. Low folate levels before conception and during pregnancy
2. ↑ a-fetoprotein levels [AFP] in amniotic and maternal serum
3. ↑ AChE in amniotic fluid [Helpful confirmatory test]
-- Fetal AChe in CSF transudates across defect into amniotic fluid

Spina bifida occulta - answer✔✔Failure of bony spinal canal to close, NO STRUCTURAL
HERNIATION
Usually seen at lower vertebral levels
DURA INTACT
Associated w/ tuft of hair or skin dimple at level of bony defect
NORMAL AFP

Meningocele - answer✔✔Meninges [BUT NO NEURAL TISSUES] herniates through bony
defect

Meningomyelocele - answer✔✔Meninges and neural tissue herniate through bony defect
Associated w/ Arnold-Chiari Type II Malformation

Anencephaly - answer✔✔Malformation of the ANTERIOR NEURAL TUBE →
1. No forebrain
2. Open calvarium
Clinical Findings:
1. ↑ a-fetoprotein levels [AFP]
2. Polyhydramnios [No swallowing center in brain]
3. Associated w/ MATERNAL TYPE I DIABETES

,©THEBRIGHT EXAM STUDY SOLUTIONS 8/19/2024 2:07 PM
4. Maternal folate supplementation ↓ risk

Holoprosencephaly - answer✔✔Failure of LEFT AND RIGHT HEMISPHERES TO
SEPARATE
Usually occurs during the 5th and 6th week
May be related to mutations in the SONIC HEDGEHOG signaling pathway
Moderate form = Cleft lip/palate
Severe form = Cyclopia
Seen in:
1. PATAU SYNDROME
2. FETAL ALCOHOL SYNDROME

Chiari Type II Malformation - answer✔✔Posterior fossa malformation
Significant HERNIATION of the CEREBELLAR TONSILS and VERMIS through FORAMEN
MAGNUM with AQUEDUCTAL STENOSIS and HYDROCEPHALUS
Patients often present w/:
1. Lumbosacral meningomyelocele
2. Paralysis below the defect

Dandy-Walker Malformation - answer✔✔AGENESIS of CEREBELLAR VERMIS with
CYSTIC ENLARGEMENT of the 4th ventricle
Fills enlarged posterior fossa
Associated w/:
1. Hydrocephalus
2. Spina bifida

Syringomyelia - answer✔✔Cystic cavity [Syrinx] within SPINAL CORD
If central canal = Hydromyelia
Crossing anterior spinal commissural fibers are typically damaged
CAPE-LIKE BILATERAL LOSS OF PAIN and TEMPERATURE in the UPPER
EXTREMITIES
Fine touch sensation is preserved
Associated w/:

, ©THEBRIGHT EXAM STUDY SOLUTIONS 8/19/2024 2:07 PM
1. Arnold Chiari malformation
2. Trauma
3. Tumor
Most common C8-T1 [CERVICAL ENLARGEMENT]

Arnold Chiari Type I Malformation - answer✔✔CEREBELLAR TONSILLAR ECTOPIA > 3-5
mm
Congenital
Usually asymptomatic in childhood
Manifests w/ HEADACHE and CEREBELLAR SYMPTOMS

Which arches form the anterior 2/3rds of the tongue - answer✔✔1st and 2nd brachial arches
-- Sensation via CN V
-- Taste via CN VII

Which arches form the posterior 1/3rd of the tongue - answer✔✔3rd and 4th brachial arches
--Sensation and taste via CN IX
-- Extreme posterior vagus

Motor innervation of the tongue - answer✔✔CN XII [Hypoglossal nerve] to:
1. Hyoglossus = Retracts and depresses tongue
2. Genioglossus = Protrudes tongue
3. Styloglossus = Draws sides of tongue upward to create a trough for swallowing
CN X [Vagus] to:
1. Palatoglossus = Elevates posterior tongue during swallowing

Neurons - answer✔✔Signal-transmitting cells of the nervous system
Permanent cells = DO NOT DIVIDE IN ADULTHOOD
Signal relaying cells w/ dendrites [Receive input], cell bodies, and axons [Send output]

CELL BODIES AND DENDRITES CAN BE SEEN ON NISSLE STAINING [Stains RER]

RER is not present in an axon

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