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United States Medicine Licensing Exam: Neurology, Quizzes of Medicine

Duke UniversityMedicine

United States Medicine Licensing Exam: NeurologyUnited States Medicine Licensing Exam: NeurologyUnited States Medicine Licensing Exam: NeurologyUnited States Medicine Licensing Exam: NeurologyUnited States Medicine Licensing Exam: Neurology

Typology: Quizzes

2025/2026

Available from 04/09/2026

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United States Medicine Licensing Exam: Neurology
Multiple Sclerosis
-Dymelenation of the CNS
-Presents with optic neuritis, MLF, hemiparesis, incontinence
-Increased IgG in CSF & plaques in MRI
-B-interferon, immunosupression & natalizumab
-Spasticity-give GABA agonist & baclofen
Long Term Potentiation
Ability of synapses to display increased efficacy after an intense stimulation
Radial Glia Function
Progenitors and cerebral cortex layering throughout life
Aneroxia Nervosa
Findings:Downy body hair, hypotension, anameia(CBC panel), cardiac
arrthymias,hypercholestrolemia, early osteoperosis, family conflict
Haloperidol
-High potency
-Block D2 receptors
-Used primarily for schzirophenia
-Side effects:extra pyramidal,hyperprolactinemia,
Antipsycholtics(Neuroleptics)-Low Potency
Chlorpromazine, Thioridazine,
Antipsychotics-High Potency
Haloperidol, Trifluoperazine,Fluphenazine
Duchenne Muscular Dystrophy
-X linked recessive(males)-dystrophin mutation
-Elevated CPK--muscle breakdown
Glioblastoma Multiforme
-Most common brain tumor
-Cross the midline-butterfly glioma
-Malignant,less than a year
Notochord becomes
pf3
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pf9
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United States Medicine Licensing Exam: Neurology

Multiple Sclerosis

  • Dymelenation of the CNS
  • Presents with optic neuritis, MLF, hemiparesis, incontinence
  • Increased IgG in CSF & plaques in MRI
  • B-interferon, immunosupression & natalizumab
  • Spasticity-give GABA agonist & baclofen Long Term Potentiation Ability of synapses to display increased efficacy after an intense stimulation Radial Glia Function Progenitors and cerebral cortex layering throughout life Aneroxia Nervosa Findings:Downy body hair, hypotension, anameia(CBC panel), cardiac arrthymias,hypercholestrolemia, early osteoperosis, family conflict Haloperidol
  • High potency
  • Block D2 receptors
  • Used primarily for schzirophenia
  • Side effects:extra pyramidal,hyperprolactinemia, Antipsycholtics(Neuroleptics)-Low Potency Chlorpromazine, Thioridazine, Antipsychotics-High Potency Haloperidol, Trifluoperazine,Fluphenazine Duchenne Muscular Dystrophy
  • X linked recessive(males)-dystrophin mutation
  • Elevated CPK--muscle breakdown Glioblastoma Multiforme
  • Most common brain tumor
  • Cross the midline-butterfly glioma
  • Malignant,less than a year Notochord becomes

Nucleus Pulposus in IV disk Proencephelon i)Telencephelon-cerebral hemispheres(lateral) ii)Diencephelon-Thalamus(third) Mesencephelon Midbrain-Aqueduct Rhombencephalon i)Metencephelon-pons & cerebellum ii)Myelencephelon-Medulla Neural crest cells becomes Schwann cells and PNS neurons Neuroectoderm becomes CNS neurons,ependymal cells,oligodedroglia,astrocytes Mesoderm becomes Microglia Locked in Syndrome Intact cerebral cortex but impaired motor function

  • Damage at pons/midbrain
  • Basilar artery damage Pupillary constriction
  • Due to spinchter pupillae muscles vi the Edinger Westphal nucles
  • Parasymphatetic Mydriasis Hypothalamus-ciliospinal center-exit T1-superior cervical ganglion-plexus internal carotid- long ciliary nerve to pupillary dilator muscle Meniere's Disease
  • Too much endolymph in inner ear
  • Vertigo, tinnitus(hearing sounds), hearing loss
  • Limit salt,anti emetics,anxiolytics & diuretics) Viral meningitis

Orthoastatic hypotension and sedative effects of neuroleptics is explained by Alpha adrenergic blocking effects SSRI

  • Fluoxetine,Paroxetine,Sertraline,Citalopram
  • Depression,Anxiety,Panic Disorder,OCD,Bulimia,,Social Phobia,PTSD
  • Reduced libido Epidural hematoma
  • Rupture of middle meningeal artery(temporal region)
  • Lucid interval with trastentorial herniation
  • CN 3 palsy(different pupil size)
  • Between the dura mater and the skull Subarachnoid hemorrage
  • Aneurysm rupture
  • Worst headache of my life
  • Bloody/yellow spinal tap Partial Seizures
  • isolated body part movement Simple partial-consciousness okay Complex partial-consciousness impacted(cannot remember) Generalized Seizures i)Absence-3Hz,blank stare,confused ii)Myoclonic-quick,repetitive jerks ii)Tonic-clonic-alternating stiffening and movement iv)Tonic-Stiffen v)Atonic-Drop seizures Atypical Antipsychotics Olanzapine,Clozapine(agranulocytosis- monitor),Quetipine,Risperidone,Aripiprazole,Ziprasidone (prolong QT) Alzheimer's Disease
  • Cortical atrophy and decrease in Ach
  • Extracellular B-amyloid plaques & neurofibillary tangles(intracellular tau protein)
  • Early onset(APP,presenilin 1&2); Late onset(APOe4)
  • Treatment:Memantine(NMDA anatagonist-to reduce glutamate); Donepezil,Glantamine,Rivastogmine(Acetylcholinesterase inhibitor) Lewy Body Demention Parkinsonism with dementia & Gullain Barre syndrome
  • Demyelenation of Schwann cells
  • Lower limbs numbness and weakness then spreads up
  • Positive albumin-cytologic dissociation
  • C.jejuni infections association(chicken)
  • Respiratory support and plasmapheresis,IV immunoglobulin ADHD
  • Associated with decreased frontal lobe volume
  • Treat with methylphenidate(stimulant),amphetamines(stimulant),atmoxetine(non stimulant) Meningioma
  • Occurs at the surface of the brain
  • From arachnoid cells and external to parenchyma
  • Beningn and asymptomatic(sometimes seizures and focal signs Oligodedroglioma
  • Usually frontal lobes(slow growing) Adenoma
  • Bitemporal heminopia
  • Can lead to hypo or hyper pituitarism Cluster B Personality Bad to the Bone Cluster A Personality Accusotory,Akward,Aloof (cannot develop relationships Cluster C Cowardly, Compulsive,Clingy Creutzfeldt-Jakob Disease

Cerebellar tonsillar herniation through foramen magnum with aqueaductal stenosis

  • Myelomeningcele and paralysis below defect Dandy-Walker
  • Absence of cerebellar vermis with 4th ventricle enlargement
  • Hydrocephalus & spina bifida Syringomyelia
  • Cystic enlargement of the central canal of spinal cord
  • Cape like bilateral loss of pain and temperature on upper extremities
  • Associated with Chiari I Tongue Development
  • Taste:2/3rd is CN7 and,1/3rd is CN9 and back is CN
  • Sensation of 2/3rd is V3 and 1/3rd is CN9,
  • Motor is by CN Neurons
  • Stained by Nissl substance(except the axon-no RER)
  • Undergoes Wallerian degeneration Functions of astrocyte
  • K metabolism
  • BBB
  • Reactive gliosis to injury
  • Marker is GFAP Microglia function
  • Phagocytotic and scavenger cells
  • HIV infected ones become multinucleated giant cells Oligoendroglia
  • Myelinate CNS(about 30)
  • Predominant glial in white matter
  • Destroyed in MS-looks like fried egg Schwann cells
  • Myelinate 1 PNS axon and promote axonal regeneration
  • Affected in Guillain Barre syndrome and acoustic neuroma Free nerve endings
  • C fibers(slow,unmyelinated)
  • A-fast,myelinated
  • Pain and temperature Meissner's corpuscles
  • Large myelinated fibers, adapt quickly
  • Dynamic, fine/light touch,position Pacinian Corpuscles
  • Large myelinated fibers
  • Vibration and pressure Merkel's discs
  • Large, myelinated fibers (adapts slowly)
  • Pressure and deep static touch Peripheral Nerve
  • Endoneurium:inflammed in Guillain Barre
  • Perineurium: must be rejoined in microsurgery
  • Epineurium:Outer layer Norephinephrine
  • Increased in Anxiety
  • Decreased in Depression
  • Locus cureleus Dopamine
  • Increased in schizophrenia
  • Decreased in Parkinsons, depression
  • Ventral tegmentum and SNc Serotonin
  • Decreased in anxiety, depression
  • Raphe nucleus Acethylcholine
  • Decreased in Alzheimers, Huntingtons
  • Increased in REM sleep
  • Basal nucleus of Meynert GABA

Circadian Rhythm VPL Thalamus Spinothalamic(Pain & Temperature), Dorsal Column(Pressure,touch,vibration,proprioception) VPM Thalamus Trigeminal and gustatory(face sensation and taste) Lateral Geniculate Nucleus From CN2 to calcarine sulcus(Vision) Medial Geniculate Nucleus

  • Superior olive and inferior colliculus to auditory cortes in temporal lobe(Hearing) Ventral Lateral Thalamus From basal ganglia to motor cortex(Motor) Limbic System
  • Amygdala,Hippocampus,Fornix,Mammilary Body,Cingulate Gyrus
  • Feeding, Fleeing, Fighting,Feeling,Sex Cerebellum
  • Contralateral cortex via middle peduncle
  • Ipsilateral proprioceptive via inferior peduncle
  • Output:Purkinje cels send to deep nuclei -->superior cerebellar Lateral Cerebellum Movement of extremities;lesion:fall ipsilateral Medial Cerebellum Balance and trunk coordination Deep nuclei of cerebellum Medial to Lateral (Dentate, Emboliform, Globose, Fastigial Basal Ganglia
  • Voluntary movement and postural adjustment
  • Provide negative feedback to cortex Direct Pathway
  • Cortex-striatum-stimulate GABA-disinhibit the thalamus via internal globus pallidus (increase motion)
  • Dopamine 1 Indirect Pathway Cortex-striatum-disinhibit subthalamic nucelus via external globus pallidus-subthalamic nuclei stimulate GPI to inhibit thalamus
  • D2 inhibit inhibitory pathway-increases motion Parkinson's Disease
  • Lewy bodies(alpha nuclein intracellular inclusion)
  • Loss of dopamine
  • Tremor,cogwheel rigidity, akinesia,postural instability Huntington Disease
  • CAG repeat on chromosome 4
  • Neuronal death via NMDA-R binding & glutamate toxicity
  • Chorea,Aggression,Depression and Dementia Hemiballismus
  • Flailing of arm;subthalamic nuclei lesion(lacunar stroke) Intention Tremor
  • Slow,zig zag motion when pointing to target
  • Cerebellar Dysfunction Amygdala Lesion Kluver-Bucy Syndrome:Hyperolality,hyperseculity,disinhibition)
  • HSV- 1 Frontal Lobe Lesion
  • Disinhibtion and deficit in concentration
  • Remergence of primitive reflex
  • Deficit in orientation and judgement Right Parietal Lobe Lesion Spatial neglect syndrome(ignore left side) Reticular activating system Lesion Reduced arousal and wakefulness(coma) Mammilary Bodies Lesion

Affects upper leg/upper arm and higher order processing Brain Perfusion Relies on PCO2(above 90mmHg)

  • Hyperventilation help reduces inter cranial pressure by reducing cerebral perfusion MCA Stroke
  • Contralateral paralysis of upper limb& face
  • Contralateral loss of sensation-upper limb &a face
  • Left:Aphasia. Right:Hemineglect ACA Stroke
  • Contralateral paralysis and loss of sensation-lower limb Lateral Striate Artery Stroke Contralateral hemiparesis/hemiplegia Anterior Spinal Artery Stroke Medial Medullary Syndrome(lateral corticospinal tract,medial lemniscus,hypoglossal nerve)
  • Contralateral hemiparesis(lower limb), decreased Contralateral proprioception & tongue deviate ipsilateral PICA Stroke
  • Lateral Medullary Syndrome(Vestibular,Lateral spinothalamic,spinal trigeminal,nucleus ambiguous,sympathetic fiber & inferior cerebellum peduncle)
  • Vomiting,Vertigo,Nystagmus;decreased pain & temperature to limbs and face;Dysphagia,Hoarseness,decreased gag reflex;Horner's syndrome;ataxia,dysmetria AICA Stroke
  • Lateral Pontine Syndrome(Vestibular,FACIAL,spinal trigeminal,cochlear and sympathetic fibers)
  • Vomiting,vertigo,nystagmus;FACE PARALYSIS,DECREASED LACRIMATION,SALIVATION,TASTE,CORNEAL REFLEX;Decreased pain and temperature to face,ipsilateral hearing decrease,Horner's syndrome;ataxia and dysmetria PCA Stroke
  • Occipital cortex & Visual Cortex
  • Contralateral hemianopia with macular sparing Anterior Communicating Artery Aneurysm Visual Field Defects

Posterior Communicating Artery Aneurysm CN 3 Palsy:eye is down and out,ptosis,pupil dilatoon Berry Aneurysm

  • Occurs at bifurcation of Willis circle(AComm)
  • Rupture causes subarachnoid haemorrhage
  • Can compress optic chiasm
  • ADKPD,Ehlers-Danlos,Marfan
  • Old age,hypertension p,smoking and blacks Charcot-Bouchard Aneurysm
  • Chronic Hypertension
  • Affects small vessels(basal ganglia,thalamus) Subdural Hematoma
  • Rupture of bridging veins,slow venous bleeding
  • Old,alcoholics,blunt trauma,shaken baby syndrome
  • Crosses suture line and midline shift
  • Cannot cross falx or tentorium Intraparenchymal Hemorrhage
  • Systemic hypertension but also seen in angioplasty,vasculitis & neoplasm
  • Occurs in basal ganglia and internal capsule Open Glaucoma Peripheral followed by central vision loss with increased intraocular pressure,old age;painless
  • Secondary causes:uveitis,trauma,corticosteroids & vas proliferation retinopathy Closed Galucoma
  • Enlargement of lens against central iris causing obstruction of normal aqueous flow:fluid builds up which push peripheral iris against cornea Closed Glaucoma(Chronic Closure) A symptomatic with damage to optic nerve & peripheral vision Closed Glaucoma(Acute Closure) Emergency as IOP push iris forward and angle close abruptly;painful with sudden vision loss
  • Halos around lights,rock hard eye,frontal headache
  • NO EPINEPHRINE

Transient Ischemic Attack Brief and reversible lasting less than 1 hour-due to focal ischemia Dural venous sinuses Empty into IJV Ventricular System of Brain Lateral-3rd:Foramen of Monro 3rd-4th:Cerebral Aqueduct 4th-Subarachnoid space:Foramina of Luschka(Lateral); Formina of Magendie(Medial) Communicating Hydrocephalus Reduced CSF absorption by arachnoid granulation-> increased ICP, papilledema & herniation Normal Pressure Hydrocephalus Increased subarachnoid volume but no increase in CSF pressure

  • Distorts corona radiata
  • Triad:urinary incontinence,ataxia,cognitive dysfunction(Wet,Wobbly & Wacky) Hydrocephalus ex vacuo
  • Increased CSF in atrophy(Alzheimer's,advanced HIV,Pick's disease)
  • Normal ICP, NO TRIAD Noncommunicating hydrocephalus Structural blockage of CSF circulation in ventricles Spinal Cord Markings Spinal Cord Border:L1-L Subarachnoid Space:Lower border of S LP done:L3/L4 OR L4/L Spinal Cord Tracts Dorsal Column Tract
  • Dorsal root ganglion-enter SC ipsilaterally-cuneatus or gracilis(middle)-decussate at medulla-ascend contrlateral to VPL
  • Pressure,vibration,fine touch,proprioception Spinothalamic Tract
  • Dorsal root ganglion-ipsilateral gray matter-decussate at anterior white commisure-ascend contralateral-VPL
  • Pain & Temperature Lateral Corticospinal Tract
  • Motor cortex-descend ipsilateral-decussate at caudal medulla-descend contralateral- anterior horn(synapse1)-lower motor neuron leaves spinal cord Upper Motor Neuron Lesion
  • Increased reflex,tone,Babinski sign,spastic paralysis and clasp knife plasticity Lower Motor Neuron Lesion
  • Decreased reflexes,tone,weakness,atrophy,fasciculations Anterior Horn Lesion
  • LMN lesion;flaccid paralysis
  • Poliomyelitis & Werdnig-Hoffman disease White matter Cervical Lesion
  • MS
  • Scanning speech,intention tremor,nystagmus ALS
  • UMN & LMN deficit with no sensory problems
  • SOD1 mutation
  • Riluzole incease survval by decreasing presynaptic glutamate release Occlusion of anterior spinal artery
  • Upper thoracic ASA territory is watershed Tabes Doralis
  • Dymyelination of dorsal column and roots-impaired sensation and proprioception
  • Associated with Charcot's joints,shooting pain,Argyll Robertson pupils
  • Absence of DTR and positive Romberg Vitamin B12 or E deficiency
  • Dymyelination of dorsal column,lateral corticospinal tract,spinocerebellar tract,ataxic gait,parethesia,impaired position and vibration sesne Poliomyelitis

Curling of fingers when palm is stroked Plantar Reflex Dorsiflexion of large toe and fanning of toes(Babinski) Galant Reflex Stroke the spine when newborn is face down cause lateral flexion towards stimulated side Cranial Nerve Nuclei at Midbrain Trigeminal Nuclei(5) Red Nucleus Trochlear Nucleus(4) Occulomotor Nucleus(3) Edinger-Westphal Nucleus(3) Cranial Nerve Nuclei at Pons Cochlear Nuclei(8) Vestibular Nuclei(8) Salivary Nulei(9,12) Facial Nucleus(7) Abducens Nuclei(6) Trigeminal Nuclei(5) Cranial Nerve Nuclei at Medulla Hypoglossal Nuclei(12) Dorsal Motor Nuclei(10) Nucleus Ambiguus(9,10,11) Solitary Nueclus(7,9,10)

  • Spinal Trigeminal Brain stem Pineal Gland Melatonin secretion Superior Colliculi Conjugate Vertical Gaze Center Inferior Colliculi Auditory Parinaud Syndrome

Paralysis of conjugate vertical gaze due to superior colliculi lesion Corneal Reflex Afferent:V1 Efferent:CN 7 Lacrimation Affrent:V1 Efferent:CN Jaw Jerk Afferent:V3 Efferent:V Pupillary Reflex Afferent:CN2 Efferent:CN Gag Reflex Afferent:CN9 Efferent:CN Friedrich's Ataxia Autosomal recessive trinucleotide repear-frataxin

  • Staggerng gait,frequent fallng,nystagmus,dysarthria,pes cavus,hammer toes,hypertrophic cardiomyopathy
  • Childhood with kyphoscoliosis Nucleus Solitaris Viscreal Sensory(Taste,Baroreceptor,Gut Distension) Nucleus Ambiguus Motor(Pharynx,Larynx,Upper Esophagus)-CN9, Dorsal Motor Nucleus Autonomic fibers to heart,lungs,upper GI-CN Cribiform Plate CN Optic Canal CN2,Opthalmic Artery,Central Retinal Vein Superior Orbital Fissure CN 3,4,V1,6,Opthalmic Vein,Symphatetic Fibers Foramen Rotundum