Exam (elaborations)
USMLE STEP 2 CK-NEUROLOGY QUESTIONS
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USMLE STEP 2 CK-NEUROLOGY QUESTIONS
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USMLE STEP 2 CK-NEUROLOGY QUESTIONSWhat is a stroke? - Answers-acute onset of focal neurologic deficits resulting from
disruption of cerebral circulation
What is the glossopharyngeal (IX) cranial nerve responsible for? - Answers-taste from
the posterior third of the tongue, oropharyngeal sensation, swallowing
(stylopharyngeus), salivation (parotid gland), monitoring carotid body and sinus chemo-
and baroreceptors
What is the facial nerve (VII) cranial nerve responsible for? - Answers-facial movement,
taste from the anterior two-thirds of the tongue, lacrimation, salivation (submandibular
and sublingual glands), eyelid closing
What is the vagus (X) cranial nerve responsible for? - Answers-Taste from the epiglottic
region, swallowing, palatal elevation, talking, thoracoabdominal, viscera, monitoring
aortic arch chemo- and barorecptors
What are the different etiologies for cardiac/aortic emboli strokes? - Answers-
Thromboemboli (AF, ventricular hypokinesis, prosthetic valves, marantic endocarditis)
Atheroemboli (aortic arch atherosclerosis)
Infectious emboli (bacterial endocarditis)
paradoxical emboli (via patent foramen ovale)
What types of hypercoagulable states put pts at risk for strokes? - Answers-
antiphospholipid abs
activated protein C resistance
malignancy
OCPs in the context of smoking
What types of craniocervical dissection put pts at risk for stroke? - Answers-trauma
fibromuscular dysplasia (young females)
inflammatory/infectious diseases
What is the fxn of the lateral corticospinal tract? - Answers-movement of contralateral
limbs
Where does the lateral corticospinal tract decussate? - Answers-pyramidal, at the
cervicomedullary jxn
What is the origin of the lateral corticospinal tract? - Answers-primary motor cortex
What is the fxn of dorsal column medial lemniscus? - Answers-fine touch, vibration,
conscious proprioception
,Where does the dorsal column medial lemniscus decussate? - Answers-arcuate fibers
at the medulla
What is the origin of the dorsal column medial lemniscus? - Answers-Pacini's and
Meissner's tactile disks, muscle spindles, and Golgi tendon organs
What is the fxn of the spinothalamic tract? - Answers-pain, temperature
Where does the spinothalamic tract decussate? - Answers-ventral white commissure at
the spinal cord level
What is the origin of the spinothalamic tract? - Answers-free nerve endings, pain fibers
What changes in tone are manifested in UMN lesions? - Answers-spastic (increased
tone); initially flaccid (decreased tone)
What changes in tone are manifested in LMN lesions? - Answers-flaccid (decreased
tone)
What is Bell's palsy? - Answers-complete destruction of the facial nucleus itself or its
branchial efferent fibers (facial nerve proper).
Peripheral ipsilateral facial paralysis w/ inability to close the eye on the involved side.
Can occur idiopathically; gradual recovery is seen in most cases. Seen as a
complication in AIDS, Lyme disease, Sarcoidosis, Tumors, and Diabetes
What facial manifestation do UMN lesions have? - Answers-lesion of the motor cortex or
the connection btw the cortex and the facial nucleus. Contralateral paralysis of the lower
face only
What facial manifestation do LMN lesions have? - Answers-ipsilateral paralysis of the
upper and lower face
What are the different types/etiologies of stroke? - Answers-Atherosclerosis
Lacunar infarcts
Cardiac/aortic emboli: thromboemboli/atheroemboli/infectious emboli/paradoxical emboli
Hypercoagulable states
Craniocervical dissection
Other: venous sinus thrombosis, sickle cell anemia, vasculitis
Are strokes mostly ischemic or hemorrhagic? - Answers-Mostly ischemic: 80%
Hemorrhagic: 20%
How are DTRs changed in UMN lesions? - Answers-increased (initially
decreased/normal)
hyperreflexive
,How are DTRs changed in LMN lesions? - Answers-decreased
hyporeflexive
How does a MCA stroke present? - Answers-aphasia (dominant hemisphere)
neglect (nondominant hemisphere)
contralateral paresis
sensory loss in the face and arm
gaze preference toward the side of the lesion
homonymous hemianopia.
How does an ACA stroke present? - Answers-contralateral paresis
sensory loss in the leg
cognitive or personality changes
How does a PCA stroke present? - Answers-homonymous hemianopia
memory deficits
dyslexia/alexia
How does a basilar artery stroke present? - Answers-coma
"locked-in" syndrome
cranial nerve palsies (eg. diplopia)
apnea
visual sx
drop attacks
dysphagia
dysarthria
vertigo
"Crossed" weakness and sensory loss affecting the ipsilateral face and contralateral
body
How does a lacunar stroke present? - Answers-pure motor or sensory stroke
dysarthria-clumsy hand syndrome
ataxic hemiparesis
How does a TIA present? - Answers-transient neurologic deficit that lasts <24hrs (most
last <1hr)
and is determined to be of ischemic in origin. Many TIAs are assoc w/ small, ASx
strokes on diffusion-weight MRI
What are the 4 deadly Ds of posterior circulation strokes? - Answers-diplopia
dizziness
dysphagia
dysarthria
How are strokes dx? - Answers-EMERGENT head CT w/o contrast to differentiate
ischemic from hemorrhagic stroke and to identify potential candidates for thrombolytic tx
, MRI: identify early ischemic changes (diffusion-weighted MRI is sensitive for acute
stroke)
EKG: an echocardiogram if embolic stroke is suspected
Vascular studies: intracranial and extracranial disease include carotid ultrasound,
transcranial Doppler, MRA, and angiography
Screen for hypercoagulable stages: w/ hx of thrombosis, in the setting of a first stroke,
or in pts <50yo
What nerve root is assoc w/ the biceps reflex? - Answers-C5
What nerve root is assoc w/ the triceps reflex? - Answers-C7
What nerve root is assoc w/ the patellar reflex? - Answers-L4
What nerve root is assoc w/ the achilles reflex? - Answers-S1
What does a positive Babinski indicate? - Answers-sign of UMN lesion
What types of lesions are seen in Poliomyelitis and Werdnig-Hoffman disease? -
Answers-LMN lesions only, due to destruction of anterior horns; flaccid paralysis
What types of lesions are seen in MS? - Answers-mostly white matter of cervical region;
random and asymmetric lesions due to demyelination; scanning to speech, intention
tremor, nystagmus
What types of lesions are seen in ALS? - Answers-combined UMN and LMN deficits w/
no sensory deficit; both UMN and LMN signs
What types of lesions are seen in complete occlusion of ventral artery? - Answers-
spares dorsal columns and tract of Lissauer
What types of lesions are seen in Tabes dorsalis (tertiary syphilis)? - Answers-
degernation of dorsal roots and dorsal columns; impaired proprioception, locomotor
ataxia
What types of lesions are seen in syringomyelia? - Answers-crossing fibers of
corticospinal tract damaged; bilateral loss of pain and temperature sensation
What types of lesions are seen in vitamin B12 neuropathy and Friedreich's ataxia? -
Answers-demyelination of dorsal columns, lateral corticospinal tracts, and
spinocerebellar tracts; ataxic gait, hyperreflexia, impaired position and vibration sense
What are modifiable risk factors for stroke? - Answers-CAD
Obesity
Atrial fibrillation
Carotid stenosis
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