USMLE STEP 2 CK FINAL EXAMS AND
ANSWERS
What is a stroke? - CORRECT ANSWER-acute onset of focal
neurologic deficits resulting from disruption of cerebral
circulation
What is the glossopharyngeal (IX) cranial nerve responsible
for? - CORRECT ANSWER-taste fro...
What is a stroke? - CORRECT ANSWER-acute onset of focal
neurologic deficits resulting from disruption of cerebral
circulation
What is the glossopharyngeal (IX) cranial nerve responsible
for? - CORRECT ANSWER-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? -
CORRECT ANSWER-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? -
CORRECT ANSWER-Taste from the epiglottic region,
swallowing, palatal elevation, talking, thoracoabdominal,
viscera, monitoring aortic arch chemo- and barorecptors
What is Bell's palsy? - CORRECT ANSWER-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? - CORRECT
ANSWER-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? - CORRECT
ANSWER-ipsilateral paralysis of the upper and lower face
What are the different types/etiologies of stroke? - CORRECT
ANSWER-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? - CORRECT
ANSWER-Mostly ischemic: 80%
Hemorrhagic: 20%
What are the different etiologies for cardiac/aortic emboli
strokes? - CORRECT ANSWER-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? - CORRECT ANSWER-antiphospholipid abs
activated protein C resistance
malignancy
OCPs in the context of smoking
,What types of craniocervical dissection put pts at risk for
stroke? - CORRECT ANSWER-trauma
fibromuscular dysplasia (young females)
inflammatory/infectious diseases
What is the fxn of the lateral corticospinal tract? - CORRECT
ANSWER-movement of contralateral limbs
Where does the lateral corticospinal tract decussate? -
CORRECT ANSWER-pyramidal, at the cervicomedullary jxn
What is the origin of the lateral corticospinal tract? - CORRECT
ANSWER-primary motor cortex
What is the fxn of dorsal column medial lemniscus? -
CORRECT ANSWER-fine touch, vibration, conscious
proprioception
Where does the dorsal column medial lemniscus decussate? -
CORRECT ANSWER-arcuate fibers at the medulla
What is the origin of the dorsal column medial lemniscus? -
CORRECT ANSWER-Pacini's and Meissner's tactile disks,
muscle spindles, and Golgi tendon organs
What is the fxn of the spinothalamic tract? - CORRECT
ANSWER-pain, temperature
Where does the spinothalamic tract decussate? - CORRECT
ANSWER-ventral white commissure at the spinal cord level
What is the origin of the spinothalamic tract? - CORRECT
ANSWER-free nerve endings, pain fibers
, What changes in tone are manifested in UMN lesions? -
CORRECT ANSWER-spastic (increased tone); initially flaccid
(decreased tone)
What changes in tone are manifested in LMN lesions? -
CORRECT ANSWER-flaccid (decreased tone)
How are DTRs changed in UMN lesions? - CORRECT
ANSWER-increased (initially decreased/normal)
hyperreflexive
How are DTRs changed in LMN lesions? - CORRECT
ANSWER-decreased
hyporeflexive
How does a MCA stroke present? - CORRECT ANSWER-
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? - CORRECT ANSWER-
contralateral paresis
sensory loss in the leg
cognitive or personality changes
How does a PCA stroke present? - CORRECT ANSWER-
homonymous hemianopia
memory deficits
dyslexia/alexia
How does a basilar artery stroke present? - CORRECT
ANSWER-coma
"locked-in" syndrome
cranial nerve palsies (eg. diplopia)
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