USMLE Step 1 Qs (13)

18 Questions | Total Attempts: 94

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USMLE Step 1 Qs (13) - Quiz

Questions from various sources for practicing


Questions and Answers
  • 1. 
    John is a 57-year-old man who has always been a very heavy drinker, often consuming 2 pints of whiskey per day, for many years. Upon the urging of his wife, he decided to seek medical attention for help with problems with his gait, which has steadily worsened over the past several months. He noticed that he now needed to stand with his feet far apart in order to maintain his balance and that he waddled when he walked. The doctor who evaluated him tested his memory and speech carefully, as well as his cranial nerves, and was unable to find any deficits. There was no weakness, sensory loss, or abnormalities in his reflexes. When asked to touch the doctor's finger, then his nose, John missed his nose slightly, but rapidly corrected the movement on both sides. When asked to slide his right heel down his left shin, his heel slid sideways and clumsily across the bone until it reached his ankle. The response with the left heel was similar. When asked to walk, John walked with his feet very far apart. If he attempted to walk in a tandem fashion, with one heel in front of the other toe, he began to fall, and the doctor needed to catch him. The doctor ordered an magnetic resonance imaging (MRI) of John's head. The region of the affected area is associated with which functional division of the cerebellum?
    • A. 

      Cerebrocerebellum

    • B. 

      Spinocerebellum

    • C. 

      Dentate nucleus

    • D. 

      Superior cerebellar peduncle

    • E. 

      Brachium pontis

  • 2. 
    John is a 57-year-old man who has always been a very heavy drinker, often consuming 2 pints of whiskey per day, for many years. Upon the urging of his wife, he decided to seek medical attention for help with problems with his gait, which has steadily worsened over the past several months. He noticed that he now needed to stand with his feet far apart in order to maintain his balance and that he waddled when he walked. The doctor who evaluated him tested his memory and speech carefully, as well as his cranial nerves, and was unable to find any deficits. There was no weakness, sensory loss, or abnormalities in his reflexes. When asked to touch the doctor's finger, then his nose, John missed his nose slightly, but rapidly corrected the movement on both sides. When asked to slide his right heel down his left shin, his heel slid sideways and clumsily across the bone until it reached his ankle. The response with the left heel was similar. When asked to walk, John walked with his feet very far apart. If he attempted to walk in a tandem fashion, with one heel in front of the other toe, he began to fall, and the doctor needed to catch him. The doctor ordered an magnetic resonance imaging (MRI) of John's head. To which deep nucleus does the damaged region project
    • A. 

      Globose

    • B. 

      Dentate

    • C. 

      Fastigial

    • D. 

      Vestibular

    • E. 

      Emboliform

  • 3. 
    John is a 57-year-old man who has always been a very heavy drinker, often consuming 2 pints of whiskey per day, for many years. Upon the urging of his wife, he decided to seek medical attention for help with problems with his gait, which has steadily worsened over the past several months. He noticed that he now needed to stand with his feet far apart in order to maintain his balance and that he waddled when he walked. The doctor who evaluated him tested his memory and speech carefully, as well as his cranial nerves, and was unable to find any deficits. There was no weakness, sensory loss, or abnormalities in his reflexes. When asked to touch the doctor's finger, then his nose, John missed his nose slightly, but rapidly corrected the movement on both sides. When asked to slide his right heel down his left shin, his heel slid sideways and clumsily across the bone until it reached his ankle. The response with the left heel was similar. When asked to walk, John walked with his feet very far apart. If he attempted to walk in a tandem fashion, with one heel in front of the other toe, he began to fall, and the doctor needed to catch him. The doctor ordered an magnetic resonance imaging (MRI) of John's head. Which cell type most likely sustained the most damage from John's alcohol consumption?
    • A. 

      Schwann cell

    • B. 

      Pyramidal cell

    • C. 

      Stellate cell

    • D. 

      Anterior horn cell

    • E. 

      Purkinje cell

  • 4. 
    A patient has an infarct involving the medial branches of the basilar root of the posterior cerebral artery. The primary region affected includes nuclei of the medial thalamus. Which of the following is one likely effect of this infarct?
    • A. 

      Grand mal epilepsy

    • B. 

      Severe acute depression and hyperphagia

    • C. 

      Drowsiness and abnormalities in memory and attention

    • D. 

      Marked somatosensory loss, including pain and temperature

    • E. 

      Upper motor neuron (UMN) paralysis

  • 5. 
    The probable basis for the effects of the infarct is the loss of processing of information from which of the following?
    • A. 

      Hypothalamus

    • B. 

      Parietal cortex

    • C. 

      Reticular formation

    • D. 

      Basal ganglion

    • E. 

      Hippocampal formation

  • 6. 
    The T2-weighted MRI scan on the left side of the figure above is of a normal patient. In the CT scan on the right side, the patient had sustained a right cerebral hemorrhage, indicated by the large white area. It is likely that the cerebrovascular accident produced which of the following?
    • A. 

      Right homonymous hemianopsia

    • B. 

      Left homonymous hemianopsia

    • C. 

      Loss of intellectual and emotional processes

    • D. 

      Aphasia

    • E. 

      Hemiparesis of the right side of the body

  • 7. 
    The blood vessel(s) affected in the figure above would most likely be the which of the following?
    • A. 

      Anterior cerebral artery

    • B. 

      Middle cerebral artery

    • C. 

      Posterior cerebral artery

    • D. 

      Superior cerebellar artery

    • E. 

      Striate arteries

  • 8. 
    The patient whose CT scan is shown in the figure below sustained an occlusion of a major artery on the left side of the brain. The most prominent deficits will most likely include which of the following?
    • A. 

      A right homonymous hemianopsia only

    • B. 

      Aphasia only

    • C. 

      A right homonymous hemianopsia coupled with aphasia

    • D. 

      Marked intellectual deficits

    • E. 

      Marked intellectual deficits coupled with hemiballism

  • 9. 
    In the figure below which of the following blood vessels is occluded?
    • A. 

      Anterior cerebral artery

    • B. 

      Middle cerebral artery

    • C. 

      Posterior cerebral artery

    • D. 

      Posterior choroidal artery

    • E. 

      Superior cerebellar artery

  • 10. 
    Jane is a 75-year-old woman who has taken medication for high blood pressure and high cholesterol for the past 10 years. One morning, upon awakening, she attempted to get up from her bed, only to find that she had difficulty walking, but didn't know why. When she tried to walk, her left leg collapsed beneath her. Jane couldn't understand why she was having so much difficulty waking, because she felt fine. Thinking that perhaps something was wrong, she edged her way across the floor to her telephone and promptly called for an ambulance. Jane hadn't noticed until now that her speech was slightly slurred. She was taken to the nearest emergency room for an evaluation. Upon arriving in the emergency room, the staff noted that her face drooped on the left and that she persistently looked to her right side, and called a neurologist to see Jane. The neurologist tested Jane's language functions by asking her to name objects, repeat sentences, and write sentences, and thought that all of these tests were normal. Her speech was mildly slurred, and she had a right gaze preference. She would not cross the midline with her eyes when asked to look to the left, but instead, immediately returned her eyes to their right-sided gaze. When asked to raise her left hand, she raised her right hand. The neurologist asked Jane if her left hand belonged to her and she replied "no, it's yours." When asked to fill in the numbers of a clock, Jane put numbers 1 through 12 on the right side of the clock. When asked to bisect a line, she placed the perpendicular line on the right side. She did not blink to hand waving in the temporal visual field of her left eye, and the nasal visual field of her right eye. Other cranial nerves were normal, except for a left facial droop that spared the forehead. Her left arm and leg were markedly weak, and the muscle tone was flaccid (floppy). All reflexes were depressed on the left side and normal on the right. The neurologist thought that all sensory modalities were depressed on the left side. The neurologist ordered a CT scan of Jane's head, and admitted her to the hospital for further workup and treatment. What kind of neurologic deficits does Jane have?
    • A. 

      Left hemiparesis, hemineglect, left homonymous hemianopsia, left hemisensory loss

    • B. 

      Left hemiparesis, right superior quadrantanopsia

    • C. 

      Left hemiparesis, left hemisensory loss, hemineglect, left superior quadrantanopsia

    • D. 

      Left hemisensory loss, hemineglect, bitemporal hemianopsia

    • E. 

      Left hemisensory loss, hemineglect, left superior quadrantanopsia

  • 11. 
    Jane is a 75-year-old woman who has taken medication for high blood pressure and high cholesterol for the past 10 years. One morning, upon awakening, she attempted to get up from her bed, only to find that she had difficulty walking, but didn't know why. When she tried to walk, her left leg collapsed beneath her. Jane couldn't understand why she was having so much difficulty waking, because she felt fine. Thinking that perhaps something was wrong, she edged her way across the floor to her telephone and promptly called for an ambulance. Jane hadn't noticed until now that her speech was slightly slurred. She was taken to the nearest emergency room for an evaluation. Upon arriving in the emergency room, the staff noted that her face drooped on the left and that she persistently looked to her right side, and called a neurologist to see Jane. The neurologist tested Jane's language functions by asking her to name objects, repeat sentences, and write sentences, and thought that all of these tests were normal. Her speech was mildly slurred, and she had a right gaze preference. She would not cross the midline with her eyes when asked to look to the left, but instead, immediately returned her eyes to their right-sided gaze. When asked to raise her left hand, she raised her right hand. The neurologist asked Jane if her left hand belonged to her and she replied "no, it's yours." When asked to fill in the numbers of a clock, Jane put numbers 1 through 12 on the right side of the clock. When asked to bisect a line, she placed the perpendicular line on the right side. She did not blink to hand waving in the temporal visual field of her left eye, and the nasal visual field of her right eye. Other cranial nerves were normal, except for a left facial droop that spared the forehead. Her left arm and leg were markedly weak, and the muscle tone was flaccid (floppy). All reflexes were depressed on the left side and normal on the right. The neurologist thought that all sensory modalities were depressed on the left side. The neurologist ordered a CT scan of Jane's head, and admitted her to the hospital for further workup and treatment. Where in the nervous system has the damage occurred?
    • A. 

      Left temporal and parietal lobes

    • B. 

      Right frontal and temporal lobe

    • C. 

      Right frontal and parietal lobes

    • D. 

      Left frontal and parietal lobes

    • E. 

      Left occipital lobe

  • 12. 
    Jane is a 75-year-old woman who has taken medication for high blood pressure and high cholesterol for the past 10 years. One morning, upon awakening, she attempted to get up from her bed, only to find that she had difficulty walking, but didn't know why. When she tried to walk, her left leg collapsed beneath her. Jane couldn't understand why she was having so much difficulty waking, because she felt fine. Thinking that perhaps something was wrong, she edged her way across the floor to her telephone and promptly called for an ambulance. Jane hadn't noticed until now that her speech was slightly slurred. She was taken to the nearest emergency room for an evaluation. Upon arriving in the emergency room, the staff noted that her face drooped on the left and that she persistently looked to her right side, and called a neurologist to see Jane. The neurologist tested Jane's language functions by asking her to name objects, repeat sentences, and write sentences, and thought that all of these tests were normal. Her speech was mildly slurred, and she had a right gaze preference. She would not cross the midline with her eyes when asked to look to the left, but instead, immediately returned her eyes to their right-sided gaze. When asked to raise her left hand, she raised her right hand. The neurologist asked Jane if her left hand belonged to her and she replied "no, it's yours." When asked to fill in the numbers of a clock, Jane put numbers 1 through 12 on the right side of the clock. When asked to bisect a line, she placed the perpendicular line on the right side. She did not blink to hand waving in the temporal visual field of her left eye, and the nasal visual field of her right eye. Other cranial nerves were normal, except for a left facial droop that spared the forehead. Her left arm and leg were markedly weak, and the muscle tone was flaccid (floppy). All reflexes were depressed on the left side and normal on the right. The neurologist thought that all sensory modalities were depressed on the left side. The neurologist ordered a CT scan of Jane's head, and admitted her to the hospital for further workup and treatment. If this damage was caused by a stroke, which artery became occluded?
    • A. 

      Right anterior cerebral artery

    • B. 

      Left anterior cerebral artery

    • C. 

      Right posterior cerebral artery

    • D. 

      Right middle cerebral artery

    • E. 

      Left middle cerebral artery

  • 13. 
    Jane is a 75-year-old woman who has taken medication for high blood pressure and high cholesterol for the past 10 years. One morning, upon awakening, she attempted to get up from her bed, only to find that she had difficulty walking, but didn't know why. When she tried to walk, her left leg collapsed beneath her. Jane couldn't understand why she was having so much difficulty waking, because she felt fine. Thinking that perhaps something was wrong, she edged her way across the floor to her telephone and promptly called for an ambulance. Jane hadn't noticed until now that her speech was slightly slurred. She was taken to the nearest emergency room for an evaluation. Upon arriving in the emergency room, the staff noted that her face drooped on the left and that she persistently looked to her right side, and called a neurologist to see Jane. The neurologist tested Jane's language functions by asking her to name objects, repeat sentences, and write sentences, and thought that all of these tests were normal. Her speech was mildly slurred, and she had a right gaze preference. She would not cross the midline with her eyes when asked to look to the left, but instead, immediately returned her eyes to their right-sided gaze. When asked to raise her left hand, she raised her right hand. The neurologist asked Jane if her left hand belonged to her and she replied "no, it's yours." When asked to fill in the numbers of a clock, Jane put numbers 1 through 12 on the right side of the clock. When asked to bisect a line, she placed the perpendicular line on the right side. She did not blink to hand waving in the temporal visual field of her left eye, and the nasal visual field of her right eye. Other cranial nerves were normal, except for a left facial droop that spared the forehead. Her left arm and leg were markedly weak, and the muscle tone was flaccid (floppy). All reflexes were depressed on the left side and normal on the right. The neurologist thought that all sensory modalities were depressed on the left side. The neurologist ordered a CT scan of Jane's head, and admitted her to the hospital for further workup and treatment. Damage to which fibers caused Jane's inability to blink in response to the hand waving in her left temporal visual field?
    • A. 

      Left facial nerve

    • B. 

      Right oculomotor nerve

    • C. 

      Left optic nerve

    • D. 

      Optic chiasm

    • E. 

      Right optic radiations

  • 14. 
    Jane is a 75-year-old woman who has taken medication for high blood pressure and high cholesterol for the past 10 years. One morning, upon awakening, she attempted to get up from her bed, only to find that she had difficulty walking, but didn't know why. When she tried to walk, her left leg collapsed beneath her. Jane couldn't understand why she was having so much difficulty waking, because she felt fine. Thinking that perhaps something was wrong, she edged her way across the floor to her telephone and promptly called for an ambulance. Jane hadn't noticed until now that her speech was slightly slurred. She was taken to the nearest emergency room for an evaluation. Upon arriving in the emergency room, the staff noted that her face drooped on the left and that she persistently looked to her right side, and called a neurologist to see Jane. The neurologist tested Jane's language functions by asking her to name objects, repeat sentences, and write sentences, and thought that all of these tests were normal. Her speech was mildly slurred, and she had a right gaze preference. She would not cross the midline with her eyes when asked to look to the left, but instead, immediately returned her eyes to their right-sided gaze. When asked to raise her left hand, she raised her right hand. The neurologist asked Jane if her left hand belonged to her and she replied "no, it's yours." When asked to fill in the numbers of a clock, Jane put numbers 1 through 12 on the right side of the clock. When asked to bisect a line, she placed the perpendicular line on the right side. She did not blink to hand waving in the temporal visual field of her left eye, and the nasal visual field of her right eye. Other cranial nerves were normal, except for a left facial droop that spared the forehead. Her left arm and leg were markedly weak, and the muscle tone was flaccid (floppy). All reflexes were depressed on the left side and normal on the right. The neurologist thought that all sensory modalities were depressed on the left side. The neurologist ordered a CT scan of Jane's head, and admitted her to the hospital for further workup and treatment. Damage to which specific area caused Jane's inability to notice the left side of her body?
    • A. 

      Left anterior frontal cortex

    • B. 

      Right anterior frontal cortex

    • C. 

      Right posterior frontal cortex

    • D. 

      Right posterior parietal cortex

    • E. 

      Right anterior parietal cortex

  • 15. 
    Bob is a 75-year-old male college graduate who was brought to a neurologist by his family because he was having problems with his gait and suffered from urinary incontinence for the past 6 months, and recently, began to have problems with his short-term memory and paying his bills. The gait problem mainly manifested itself as difficulty in climbing stairs and frequent falls. Bob had no past medical history other than a subarachnoid hemorrhage resulting from a ruptured cerebral aneurysm many years earlier. When the neurologist examined Bob, she found that he could not remember three objects 5 minutes after they were shown to him, even when he was prompted. He was unable to figure out how many quarters were in $1.75, and spelled the word world incorrectly. A grasp reflex (squeezing the examiner's hand as a reflex reaction to stroking of the palm) was present. Although his motor strength was full in all of his extremities, when asked to walk, he took many steps in the same place without moving forward, then started to fall. His cranial nerve, sensory, and cerebellar examinations were normal. Bob has a grasp reflex and dementia. A lesion in which region can cause this deficit?
    • A. 

      Occipital lobe

    • B. 

      Frontal lobe

    • C. 

      Medulla

    • D. 

      Thalamus

    • E. 

      Pons

  • 16. 
    Bob is a 75-year-old male college graduate who was brought to a neurologist by his family because he was having problems with his gait and suffered from urinary incontinence for the past 6 months, and recently, began to have problems with his short-term memory and paying his bills. The gait problem mainly manifested itself as difficulty in climbing stairs and frequent falls. Bob had no past medical history other than a subarachnoid hemorrhage resulting from a ruptured cerebral aneurysm many years earlier. When the neurologist examined Bob, she found that he could not remember three objects 5 minutes after they were shown to him, even when he was prompted. He was unable to figure out how many quarters were in $1.75, and spelled the word world incorrectly. A grasp reflex (squeezing the examiner''''s hand as a reflex reaction to stroking of the palm) was present. Although his motor strength was full in all of his extremities, when asked to walk, he took many steps in the same place without moving forward, then started to fall. His cranial nerve, sensory, and cerebellar examinations were normal. You are asked to evaluate Bob with the neurologist. The nurse in the office asks if you would like to order a CT scan, and you request one. The CT scan shows that all the ventricles are dilated, especially the frontal horns of the lateral ventricles, without any evidence of obstruction by a tumor. What would be a possible mechanism underlying the enlargement of the ventricles?
    • A. 

      Decreased cerebrospinal fluid (CSF) absorption

    • B. 

      Low blood pressure

    • C. 

      Decreased central nervous system (CNS) blood flow

    • D. 

      Decreased intracranial pressure

    • E. 

      High blood pressure

  • 17. 
    Bob is a 75-year-old male college graduate who was brought to a neurologist by his family because he was having problems with his gait and suffered from urinary incontinence for the past 6 months, and recently, began to have problems with his short-term memory and paying his bills. The gait problem mainly manifested itself as difficulty in climbing stairs and frequent falls. Bob had no past medical history other than a subarachnoid hemorrhage resulting from a ruptured cerebral aneurysm many years earlier. When the neurologist examined Bob, she found that he could not remember three objects 5 minutes after they were shown to him, even when he was prompted. He was unable to figure out how many quarters were in $1.75, and spelled the word world incorrectly. A grasp reflex (squeezing the examiner''s hand as a reflex reaction to stroking of the palm) was present. Although his motor strength was full in all of his extremities, when asked to walk, he took many steps in the same place without moving forward, then started to fall. His cranial nerve, sensory, and cerebellar examinations were normal. A CT scan shows that all the ventricles are dilated, especially the frontal horns of the lateral ventricles, without any evidence of obstruction by a tumor. If there is diminished CSF absorption, where does the blockage occur?
    • A. 

      Pyramidal cells

    • B. 

      Renshaw cells

    • C. 

      Arachnoid villi

    • D. 

      Purkinje cells

    • E. 

      Sagittal sinus

  • 18. 
    Bob is a 75-year-old male college graduate who was brought to a neurologist by his family because he was having problems with his gait and suffered from urinary incontinence for the past 6 months, and recently, began to have problems with his short-term memory and paying his bills. The gait problem mainly manifested itself as difficulty in climbing stairs and frequent falls. Bob had no past medical history other than a subarachnoid hemorrhage resulting from a ruptured cerebral aneurysm many years earlier. When the neurologist examined Bob, she found that he could not remember three objects 5 minutes after they were shown to him, even when he was prompted. He was unable to figure out how many quarters were in $1.75, and spelled the word world incorrectly. A grasp reflex (squeezing the examiner''s hand as a reflex reaction to stroking of the palm) was present. Although his motor strength was full in all of his extremities, when asked to walk, he took many steps in the same place without moving forward, then started to fall. His cranial nerve, sensory, and cerebellar examinations were normal. A CT scan shows that all the ventricles are dilated, especially the frontal horns of the lateral ventricles, without any evidence of obstruction by a tumor where would the greatest damage be done by the expanding ventricles?
    • A. 

      Thalamus

    • B. 

      Brainstem

    • C. 

      Pituitary gland

    • D. 

      Parietal cortex

    • E. 

      Deep frontal white matter (corona radiata)

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